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Home My WebLink About20091873.tiffWECY MEMORANDUM DATE: July 30. 2009 T0: C. FROM COLORADO RE: William F. Garcia. Chair, Weld County Boar of Commissi ers Judy A. Griego, Director, Human Services iarcm�e t\i- r (-(1 Agreement to Purchase Out -of -Home Placement Services between the Weld County Department of Human Services and Various Contractors to be Placed on the Consent Agenda Enclosed for Board approval are Agreements to Purchase Out -of -Home Placement Services between the Weld County Department of Human Services and Contractors listed below. Please place on the Consent Agenda. Below arc the major provisions of the attached Agreements: No. Type of Facility/Location Facility Name/Tenn I A Kidz Hope Homes, Inc. July 1. 2009 — June 30, 2010 Group Home/Group Center Colorado Springs, Colorado 2 Adoption Alliance July 1, 2009 — June 30, 2010 Child Placement Agency Denver, Colorado 3 Adoption Options July 1, 2009 —June 30, 2010 Child Placement Agency Aurora, Colorado 4 Alternative Homes for Youth July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Dacono, Colorado 5 Bethany Christian Services July 1.2009 — June 30, 2010 Child Placement Agency Colorado Springs, Colorado 6 C & E Group Home July 1, 2009 — June 30, 2010 Group Home/Group Center Greeley, Colorado 7 C & M Group Home July I, 2009— June 30, 2010 Group Home/Group Center Greeley, Colorado 8 Childrens Ark, Inc. July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Green Mountain Falls. Colorado 9 Courthouse, Inc. July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Englewood, Colorado Cenci tit Ac t'tdla vv. I I 2009-1873 10 Dcvereux Cleo Wallace July 1, 2009 — June 30, 2010 Psychiatric Residential Treatment Facility Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Westminster, Colorado 11 Earl and Cindy Almond July 1.2009 — June 30. 2010 Group Home/Group Center Greeley, Colorado 12 13 El Pueblo Boys' and Girls: Ranch July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Pueblo, Colorado Excelsior Youth Centers July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Aurora, Colorado 14 Flatirons Behavioral Health Hospital Corp. July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Louisville, Colorado 15 Gateway Youth and Family July 1, 2009 — June 30, 2010 Child Placement Agency Grand Junction, Colorado 16 Griffith Center for Youth July 1, 2009 — June 30, 2010 Child Placement Agency Group Home/Group Center Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Lakewood, Colorado 17 Heritage House July 1, 2009 — June 30, 2010 Group Home/Group Center Louisville, Colorado 18 Hope Family Services July 1, 2009 — June 30, 2010 Child Placement Agency Group Home/Group Center Greeley, Colorado 19 Indiana Development Training Center July 1, 2009 — June 30, 2010 Residential Child Care Facility Indianapolis, Indiana 20 Jefferson Hills July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Lakewood. Colorado 21 Kids Crossing July 1.2009 — June 30, 2010 Child Placement Agency Group Home/Group Center Colorado Springs, Colorado 22 Marie Alirez Group Home July 1, 2009 — June 30, 2010 Group Home/Group Center Greeley, Colorado 23 Michael Alirez Group Home July 1, 2009 — June 30, 2010 Group Home/Group Center Greeley, Colorado 24 Mount St. Vincent Home July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Denver, Colorado 25 Mountain Crest Poudrc Valley Health Care, Inc. D/B/A Poudrc Valley Hospital July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Fort Collins, Colorado 26 Mountain Star Center July I, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Denver, Colorado 27 PSI Cedar Springs Hospital, Inc. July 1, 2009 — Junc 30, 2010 Psychiatric Residential Treatment Facility Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Colorado Springs, Colorado 28 Tennyson Center for Children July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Denver, Colorado 29 The University of Colorado Health Sciences Center dba Synergy July 1, 2009 — Junc 30, 2010 Residential Child Carc Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Denver, Colorado 30 Third Way Center July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Denver, Colorado 31 Turning Point Center for Youth July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Fort Collins, Colorado 32 Youth Ventures of Colorado July 1.2009 — June 30, 2010 Child Placement Agency Group Home/Group Ccntcr Colorado Springs, Colorado 33 Youth Villages July 1, 2009 — June 30, 2010 Residential Child Care Facility Memphis, Tennessee 34 Youth Track July 1, 2009 — June 30, 2010 Residential Child Care Facility Therapeutic Residential Child Care Facility Transition/Home Based After -Care Longmont, Colorado If you have any questions, give me a call at extension 6510. COLORADO TO: FROM: DATE: SUBJECT: DEPARTMENT OF HUMAN SERVICES P.O. BOX A GREELEY, CO. 80632 Website: ns%w.co.wcld.co.us Administration and Public Assistance (970) 352-1551 Child Support (970) 352-6933 MEMORANDUM Judy Griego — Director Lesley Cobb'- Child Welfare Rate Negotiator July 22, 2009 The Agreement to Purchase Out -Of -Home Placement Services contracts. Attached please find the Agreement to Purchase Out -Of -Home Placement Service Contracts for the following providers: Weld County Out -of -Home Placement Providers 2009-2010 A Kidz Hope Homes 1 Inc. 2 Adoption Alliance 3 Adoption Options Alternative Homes For 4 Youth Bethany Christian 5 Services 6 C & E Group Home 7 C & M Group Home 8 Childrens Ark, Inc 9 Courthouse Inc. 10 Devereux Cleo Wallace 11 Earl and Cindy Almond El Pueblo Boys' and 12 Girls' Ranch 13 Excelsior Youth Centers 1401 W Colorado Ave 2121 S. Oneda St, Suite 420 13900 E Harvard Ave, Suite 200 PO Box 9 4820 Rusina Rd, Suite C 10101 W 13th Street Rd 1920 81st Ave 10460 W Hwy 24 333 W Hampden Ave, Suite 305 8405 Church Ranch Blvd 1937 Chestnut Ave One El Pueblo Ranch Way 15001 E. Oxford Ave Colorado Springs, CO 80904 Denver, CO 80224 Aurora, CO 80014 Dacono, CO 80514 Colorado Springs, CO 80907-8127 Greeley, CO 80634 Greeley, CO 80634 Green Mountain Falls, CO 80819 Englewood, CO 80110-2333 Westminster, CO 80021 Greeley, CO 80631 Pueblo, CO 81006 Aurora, CO 80014 Ip Flatirons Behavioral 14 Health Hospital, Corp Gateway Youth and 15 Family Griffith Center for 16 Children 17 Heritage House 18 Hope Family Services Indiana Developmental 19 Training Center 20 Jefferson Hills 21 Kids Crossing Marie Alirez Group 22 Home Michael Alirez Group 23 Home Mount St. Vincent 24 Home Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley 25 Hospital 26 Mountain Star Center PSI Cedar Springs 27 Hospital, Inc. Tennyson Center for 28 Children The University of Colorado Health Sciences Center dba 29 Synergy 30 Third Way Center Turning Point Center for 31 Youth Youth Ventures of 32 Colorado 33 Youth Villages 34 Youthtrack 2255 S 88th Street 740 Gunnison Ave 14142 Denver West Pkwy, Suite 225 PO Box 195 1610 29th Ave Place #100 11075 North Pennsylvania Street 421 Zang St 1440 E Fountain Blvd 1405 26th Street 1709 37th Ave 4159 Lowell Blvd 4601 Corbett DR 3520 W Oxford Ave 2135 Southgate Rd 2950 Tennyson St 3738 W Princeton Cir PO Box 61385 1644 South College Ave 4785 Granby Cir PO Box 341154 1375 Ken Pratt Blvd Louisville, CO 80027 Grand Junction, CO 81501 Lakewood, CO 80401 Louisville, CO 80027 Greeley, CO 80634 Indianapolis, IN 46280 Lakewood, CO 80228 Colorado Springs, CO 80910-3502 Greeley, CO 80631 Greeley, CO 80634 Denver, CO 80211 Fort Collins, CO, 80528 Denver, CO 80236 Colorado Springs, CO 80906-2605 Denver, CO 80212-3029 Denver, CO 80236 Denver, CO 80206 Fort Collins, CO 80525 Colorado Springs, CO 80919 Memphis, TN 38184-1154 Longmont, CO 80501 These contracts have been presented for consent approval to the Board of County Commissioners however; I am requesting your signature along with the Boards to complete these contracts for the FY 2009-2010. If you have any questions please call me at Ext. 6441. AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A Z CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of „.,9 between the Weld County Department of Social/Human Services he 4-i I. fter called "County" and A Kidz Hope Homes Inc., 1401 W Colorado Ave, Colorado Springs, CO 80904, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and A Kidz Hope Homes Inc.. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 5,2crey - /J'73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board Deputy ' lerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: B WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2008 CONTRACTOR A Kidz Hope Homes Inc. 1401 W Colorado Ave Colorado Springs, CO 80904 11 SS -23A revised 2/09 a'c?C'9 _ /x'73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day of ^ ) between the Weld County Department of Social/Human Services h ein er called "County" and Adoption Alliance, 2121 S. Oneda St, Suite 420, Denver, CO 80224, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Adoption Alliance. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 _.)rc i -4193 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION H - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board 12.4ad By: Deputy r 74-7 erk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: vv, Chair Signature AUG 0 5 2009 CONTRACTOR Adoption Alliance 2121 S. Oneda St, Suite 420 Denver, CO 80224 By: 11 SS -23A revised 2/09 �r; /S)23 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): • THIS AGREEMENT, made this u;L day of Ilk . " elnetween the Weld County Department of Social/Human Services hereinaftet called "County" and Adoption Options, 13900 E Harvard Ave, Suite 200, Aurora, CO 80014, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Adoption Options. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS I . Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. E Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By:/fr;ii( .>C-5/ / Deputy Cork to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: `T :�lV Glk Ct,_-r}(I) C& 4- ue�ti2- Directo>� _I h ki4C Lu o..h J ) AN f Z By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Siature AUG 0 5 2009 CONTRACTOR Adoption Options 13900 E Harvard Ave, Suite 200 Aurora, CO 80014 1(1 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) Z RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ( day of between the Weld County Department of Social/Human Services re after called "County" and Alternative Homes For Youth, PO Box 9, Dacono, CO 80514, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Alternative Homes For Youth. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 „a -2 -)6/ ---/?-7 3 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By: Deputy:.' erk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: �!/ 1 C� [ Chair Signature, AUG 0 5 2009 CONTRACTOR Alternative Homes For Youth PO Box 9 Dacono, CO 80514 11 SS -23A revised 2/09 ;k6.1 -/L AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this I day of between the Weld County Department of Social/Human Services he ' in er called "County" and Bethany Christian Services, 4820 Rusina Rd, Suite C, Colorado Springs, CO 80907-8127, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Bethany Christian Services. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 = c o` - /3'7- NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: I . Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (I) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board gutil BY/Z: G, _ Deputy CI eflc to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES ti)t Chair Signature AUG 0 5 2009 CONTRACTOR Bethany Christian Services 4820 Rusina Rd, Suite C Colorado Springs, CO 80907 By:j &NA) 17-2, 11 SS -23A revised 2/09 cyCCI — /&'/,j AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of �� `4�f between the Weld County Department of Social/Human Services hereinafter called "County" and C & E Group Home, 10101 W 13th Street Rd, Greeley, CO 80634, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and C & E Group Home. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board B LA/1/44/ Deputy C •rk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: Chair Siglature AUG Q 5 1009 CONTRACTOR C & E Group Home 10101 W 13th Street Rd Greeley, CO 80634 By: �'_4et 11 SS -23A revised 2/09 _ Oc/ -/g% AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) El CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE El INDEPENDENT LIVING El PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE El SUBSIDIZED ADOPTION El THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) El OTHER (DESCRIBE): THIS AGREEMENT, made this / 11day of �� % between the Weld County Department of Social/Human Services hereinaftet called "County" and C & M Group Home, 1920 81st Ave, Greeley, CO 80634, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and C & M Group Home. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 -9CY" % -/ '73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to t • :oard Deputy Clerk to the Board Chair Signature AUG 0 5 2009 Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR C & M Group Home 1920 81st Ave Greeley, CO 80634 11 SS -23A revised 2/09 .9212•-/ 2S AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this 1 51 day of t c L/ between the Weld County Department of Social/Human Services hereinafter called "County" and Childrens Ark, Inc, 10460 W Hwy 24, Green Mountain Falls, CO 80819, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Childrens Ark, Inc. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 6 1 SS -23A revised 2/09 Dee; -- / if 7 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to =.ard By: L ;"ice jy " By: DeputyClerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES 80819 Chair Signature AUG 0 5 2009 By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR Childrens Ark, Inc 10460 W Hwy 24 Green Mountain Falls, CO SS -23A revised 2/09 11 ,_9(c)2. -/f73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of i.� 009 between the Weld County Department of Social/Human Services her:/na i'e called "County" and Courthouse Inc., 333 W Hampden Ave, Suite 305, Englewood, CO 80111-2333, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Courthouse Inc.. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: I . This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION 1- DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board iatedi By: `% Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR Courthouse Inc. 333 W Hampden Ave, Suite 305 Englewood, CO 80111-2333 11 SS -23A revised 2/09 9v2-/fi 3 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ® PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ( day of )� 2 '' between the Weld County Department of Social/Human Services her Fin er called "County" and Devereux Cleo Wallace, 8405 Church Ranch Blvd, Westminster, CO 80021, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Devereux Cleo Wallace. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board B DeputyJerk to th Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Si ature AUG 0 5 2009 CONTRACTOR Devereux Cleo Wallace 8405 Church Ranch Blvd Westminster, CO 80021 ( L CLI_ (0 (33 31 11 SS -23A revised 2/09 -_92%2 - /:x'/31 • AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): r THIS AGREEMENT, made this / day of '-`), , , between the Weld County Department of Social/Human Services hereinafter called "County" and Earl and Cindy Almond, 1937 Chestnut Ave, Greeley, CO 80631, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Earl and Cindy Almond. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 a'cx /y73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHAP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. K 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to SS -23A revised 2/09 6 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk tard B erk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: h -1/4 2 2 — h it Signature AUG 0 5 2009 CONTRACTOR Earl and Cindy Almond 1937 Chestnut Ave Greeley, CO 80631 11 SS -23A revised 2/09 ,9069- %"73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) is RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of � ()CUM between the Weld County Department of Social/Human Services •r:f' after called "County" and El Pueblo Boys' and Girls' Ranch, One El Pueblo Ranch Way, Pueblo, CO 81006, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and El Pueblo Boys' and Girls' Ranch. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social. /Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. SS -23A revised 2/09 91��1-lc,• 1 _QG69-"P73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board ilk Deputy lerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR El Pueblo Boys' and Girls' Ranch One El Pueblo Ranch Way Pueblo, CO 81006 By: "-1�-- CT,`�c€-� 11 SS -23A revised 2/09 -/f73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING El PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE El SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of o2b09 between the Weld County Department of Social/Human Services he in er called "County" and Excelsior Youth Centers, 15001 E. Oxford Ave, Aurora, CO 80014, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Excelsior Youth Centers. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 _CG%-/k'7S NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Coard B Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR Excelsior Youth Centers 15001 E. Oxford Ave Aurora, CO 80014 By1 Q J .;•X;` By: O.01K', t C Director I) 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of f ^ between the Weld County Department of Social/Human Services h et er called "County" and Flatirons Behavioral Health Hospital, Corp., 2255 S 88th Street, Louisville, CO 80027, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Flatirons Behavioral Health Hospital, Corp.. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 LYfr9-/, 3 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By:/ !l!;/c lt_ Deputy C eYrk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: hair Signature AUG 0 5 2009 By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR Flatirons Behavioral Health Hospital, Corp. 2255 S 88th Street Louisville, CO 80027 SS -23A revised 2/09 11 L.32 -Cc: AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day of between the Weld County Department of Social/Human Services he ei E ter called "County" and Gateway Youth and Family, 740 Gunnison Ave, Grand Junction, CO 81501, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Gateway Youth and Family. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. e 1 SS -23A revised 2/09 L9(e9,- /e73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement maybe renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the teen of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (I) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk t By: //2f i'i .P /' ...c By: Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES C Chair Signature AUG 0 5 2009 CONTRACTOR Gateway Youth and Family 740 Gunnison Ave Grand Junction, CO 81501 r By: t(44,;,,,,, CR41 11 SS -23A revised 2/09 ;4" �`/ - /S'73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) El RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) El OTHER (DESCRIBE): THIS AGREEMENT, made this / day of —Su c 1 between the Weld County Department of Social/Human Services hereinafter called "County" and Griffith Center for Children, 14142 Denver West Pkwy, Suite 225, Lakewood, CO 80401, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Griffith Center for Children. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 k2'C9- /?23 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shalt insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan maybe utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Depaitinent of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Depaitinent of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to • - : sard By'%/-'%,.. Deputy C erk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES B By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR Griffith Center for Children 14142 Denver West Pkwy, Suite 225 Lakewood, CO 80401 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ( day of between the Weld County Department of Social/Human Services h after called "County" and Heritage House, PO Box 195, Louisville, CO 80027, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Heritage House. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 L %- /"%3 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board gteSaAti By: Deputy Clerk to the Board' Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR Heritage House PO Box 195 Louisville, CO 80027 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) IN GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this 1 day of /,._ . ��r between the Weld County Department of Social/Human Services ,:� a er called "County" and Hope Family Services, 1610 29th Ave Place #100, Greeley, CO 80634, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Hope Family Services. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 CO - /cf73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Cle By////f/2C�<;/ _( ;e �./ Deputy Cork to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: Chair Signature AUG 0 5 2009 WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES C' CONTRACTOR Hope Family Services 1610 29th Ave Place #100 Greeley, CO 80634 11 SS -23A revised 2/09 -2CO % --9(12 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of Yu kg between the Weld County Department of Social/Human Services hereinafter called "County" and Indiana Developmental Training Center, 11075 North Pennsylvania Street, Indianapolis, IN 46280, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Indiana Developmental Training Center. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 c9-/273 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to;� .� and WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: /l n� By: Deputy Ork to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: B Chair Signature AUG 0 5 ?009 CONTRACTOR Indiana Developmental Training Center 11075 North Pennsylvania St Indianapolis A ; 6280 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day ofbetween the Weld County Department of Social/Human Services hefter called "County" and Jefferson Hills, 421 Zang St, Lakewood, CO 80228, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Jefferson Hills. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to__oard By:46/, /id: T `I t ;/t Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: B WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES air Signature AUG 0 5 ?Pc] CONTRACTOR Jefferson Hills 421 Zang St Lakewood, CO 80228 By: / 2 -c2 -cc 11 SS -23A revised 2/09 e(52-/ 73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ) day of between the Weld County Department of Social/Human Services h e' fter called "County" and Kids Crossing, 1440 E Fountain Blvd, Colorado Springs, CO 80910-3502, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Kids Crossing. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 a�lD%-/f73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to Board By: ji" /c . : By: Deputy C erk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES —7 Chair Signature AUG 0 5 2009 CONTRACTOR Kids Crossing 1440 E Fountain Blvd Colorado Springs, CO 80910 11 SS -23A revised 2/09 .fin%% - /�'__ AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this f 51 day of J5t.l L c between the Weld County Department of Social/Human Services hereinafte!called "County" and Marie Alirez Group Home, 1405 26th Street, Greeley, CO 80631, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Marie Alirez Group Home. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 ,_1CY� 2 -7f≥' NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of finds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk tQYe card B Deputy C%rk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: -1�� Chair Signature AUG 0 5 2009 CONTRACTOR Marie Alirez Group Home 1405 26th Street Greeley, CO 80631 By: l / o,AA ' O e 3 11 SS -23A revised 2/09 see -2 - /f>73 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of ] ,ALq between the Weld County Department of Social/Human Services hereinafter called "County" and Michael Alirez Group Home, 1709 37th Ave, Greeley, CO 80634, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Michael Alirez Group Home. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Depai lment of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By: l`>>/%!t Deputy C1 rk to the Boarh— Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERY4CES By: Chair Signature AUG r, CONTRACTOR Michael Alirez Group Home 1709 37th Ave Greeley, CO 80634 11 SS -23A revised 2/09 *Yric9 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ( day of �L.. °bD between the Weld County Department of Social/Human Services he • i (fter called "County" and Mount St. Vincent Home, 4159 Lowell Blvd, Denver, CO 80211, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Mount St. Vincent Home. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 9(6I—/cj7j NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (I) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to 'Board B Deputy C rk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 'POP CONTRACTOR Mount St. Vincent Home 4159 Lowell Blvd Denver, CO 80211 By: -Jy� 11 SS -23A revised 2/09 et 9 /g'7 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) 1j RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION Z THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this i day of 4 ` between the Weld County Department of Social/Human Services he ei after called "County" and Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley Hospital, 4601 Corbett DR, Fort Collins, CO, 80528, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley Hospital. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic 1 SS -23A revised 2/09 CC' 9 -JrI3 Residential Child Care Facility, or meets the requirements for other licensed service types. NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is 2 SS -23A revised 2/09 completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off wounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Depai tment of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board Deputy ' erk to the Board 7 Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG n 5 ZJ09 CONTRACTOR Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley Hospital 4601 Corbett Dr Fort Collins, CO, 80528 By: 0 CI - .-vi 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day of GO 0 between the Weld County Department of Social/Human Services hft•r called "County" and Mountain Star Center, 3520 W Oxford Ave, Denver, CO 80236, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Mountain Star Center. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 c9-/ 7S NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS I . Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MM1S System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the t 5th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG 0 5 2009 CONTRACTOR Mountain Star Center 3520 W Oxford Ave Denver, CO 80236 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ® PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this ,Q day of, To/ vi ,2ecl between the Weld County Department of Social/Human Services hereinafter called "County" and PSI Cedar Springs Hospital, Inc., 2135 Southgate Rd, Colorado Springs, CO 80906- 2605, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and PSI Cedar Springs Hospital, Inc.. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 9ce 73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCF's, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number I0 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board B Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES 2605 WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG r F "^nn CONTRACTOR PSI Cedar Springs Hospital, Inc. 2135 Southgate Rd Colorado Springs, CO 80906 - By: -7/ O t� n!f( SS -23A revised 2/09 11 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ElRESIDENTIAL CHILD CARE FACILITY (RCCF) RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this 1 day of 18 Lry between the Weld County Department of Social/Human Services her inafter called "County" and Tennyson Center for Children, 2950 Tennyson St, Denver, CO 80212-3029, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Tennyson Center for Children. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk tom, 1 By: j CI /C/ -' c e`r'/ e`,1772 Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG G 5 2009 CONTRACTOR Tennyson Center for Children 2950 Tennyson St Denver, CO 80212-3029 By: QL/V\ r ,-. _:/i L (\ tea.,.... HY-i ,,,,: h L; S.-- . (a, 4 c L SS -23A revised 2/09 11 7G'6 —/a9 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day of Ao0 between the Weld County Department of Social/Human Services r after called "County" and The University of Colorado Health Sciences Center dba Synergy, 3738 W Princeton Cir, Denver, CO 80236, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and The University of Colorado Health Sciences Center dba Synergy. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 ,3,7(69- /J>73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to t � By: C /Zii:(rr - ,-% Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SE$VICES Chair S CONTRACTOR The University of Colorado r peel Ver dba Synergy 3738 W Princeton Cir Denver, CO 80236 71-/z -- Wo5 Christine Ahearn Asst. Director Contracts, .'olicy and Education Office of Grants and Contracts 11 SS -23A revised 2/09 51c{9 -AP, AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) Z TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of between the Weld County Department of Social/Human Services heer called "County" and Third Way Center, PO Box 61385, Denver, CO 80206, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Third Way Center. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 /5,W9 -/P7.' NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan maybe utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: I. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Depaitwuent of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must he posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to BY' t -t/ r ..lc . Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: Chair Signature AUG 0 5 ?nog By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR Third Way Center PO Box 61385 Denver, CO 80206 11 SS -23A revised 2/09 e2-/ers AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) RESIDENTIAL CHILD CARE FACILITY (RCCF) RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ® THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this I day of ( qp[t between the Weld County Department of Social/Human Services h ein ffer called "County" and Turning Point Center for Youth, 1644 South College Ave, Fort Collins, CO 80525, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Turning Point Center for Youth. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 1 th-/9Z NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: I . Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as maybe designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SVICES Chair Signature AUG p 5 ?ono CONTRACTOR Turning Point Center for Youth 1644 South College Ave Fort Collins, CO 80525 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of , between the Weld County Department of Social/Human Services he .^. fter called "County" and Youth Ventures of Colorado, 4785 Granby Cir, Colorado Springs, CO 80919, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Youth Ventures of Colorado. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 cr9-/573 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHAP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By: Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AUG C 5 mnq CONTRACTOR Youth Ventures of Colorado 4785 Granby Cir Colorado Springs, CO 80919 11 SS -23A revised 2/09 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this / day of between the Weld County Department of Social/Human Services he i er called "County" and Youth Villages, PO Box 341154, Memphis, TN 38184-1154, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Youth Villages. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. I SS -23A revised 2/09 :i9ooi- /S=/3 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board By C_ _ Deputy Clerk to the Boaiil-'`;' Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES hair Signature AUG n r ' nq CONTRACTOR Youth Villages PO Box 341154 Memphis, TN 38.1-54 CEO 11 SS -23A revised 2/09 (:e9 - Af'%3 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF) ® TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT, made this day of v0 y between the Weld County Department of Social/Human Services he i ft'er called "County" and Youthtrack, 1375 Ken Pratt Blvd, Longmont, CO 80501, hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld County Department of Social/Human Services and Youthtrack. A child specific addendum, identifying individual service needs, must be completed and attached to supplement this agreement for each child being served by the facility. If this is a CPA placement, the child specific addendum should also address how administrative services will be provided in the event the child is placed for adoption in a foster home supervised by the CPA. WHEREAS, the Colorado State Department of Human Services, hereinafter called "State Department" is authorized to provide social services to individuals and families of individuals through its agents, County Departments of Social/Human Services, and WHEREAS, the County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, the County wishes to provide these services by purchasing them from Contractor, and, WHEREAS, the Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, Therapeutic Residential Child Care Facility, or meets the requirements for other licensed service types. 1 SS -23A revised 2/09 a9c 9-/F73 NOW THEREFORE, it is hereby agreed that in consideration of the mutual undertakings the County and the Contractor agree as follows: 1. This Agreement shall be in force from the date of the agreement, July 1, 2009, until the end of the Colorado fiscal year, June 30, 2010. Any child may be removed from the facility prior to the end of the fiscal year by the county department. 2. This Agreement may be renewed only by entering into a new written Agreement such as this Agreement signed by the authorized representatives of the parties. Except as otherwise provided above, either party shall have the right to terminate this contract by giving the other party thirty (30) days notice by registered mail, return receipt requested. If notice is so given, this contract shall terminate on the expiration of the thirty (30) days or until the eligible child(ren) can be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease, but the parties shall not be released from the duty to perform their obligations up to the date of termination. 3. This Agreement is in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. SECTION I - DESCRIPTION OF SERVICES TO BE PURCHASED 1. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for TRCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; for RCCF placements the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and the Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. 2. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). 3. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from the Contractor's facility, the County shall provide transportation to either return the child to the facility or to other care as arranged by the 2 SS -23A revised 2/09 County. The County has responsibility for the decision to return the child to the facility, with input from the Contractor. 4. All other transportation associated with the Contractor's proposed services will be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. 5. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this contract, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SECTION II - LEGAL STATUS AND AUTHORIZATIONS 1. Such permission as is held by the County is hereby granted to the Contractor to authorize routine or emergency medical and dental treatment except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 - day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with the Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 3 SS -23A revised 2/09 SECTION III - REASONS FOR REFERRAL, TREATMENT PLAN, AND PROGRESS REPORTS 1. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children are specified in the attached child specific addendum and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the addendum. 2. County and Contractor shall develop an initial plan that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in TRCCFs, RCCFs or group homes except PRTF. County and Contractor shall formulate an initial individual plan of care within 14 calendar days after admission for children in TRCCFs, RCCFs or group homes except PRTF. The placement date is that date noted in the attached child specific addendum included with this contract. The Child's Family Service Plan may be utilized as an Individual Plan of Care for this purpose for facilities. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 3. County and Contractor shall formulate an initial individual plan of care for children in PRTFs within 72 hours. For children in a PRTF a comprehensive individual plan of care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the attached child specific addendum included with this contract. Modifications to this plan shall be agreed to in writing on the plan or as a supplemental document. 4. The individual plan of care shall be goal oriented and time -limited and shall: a. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. b. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. c. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. d. Specify that all TRCCF services are necessary to meet the needs of the child and to treat the child's current diagnosis. 4 SS -23A revised 2/09 e. Identify the provision of, or the referral for, services other than TRCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. f. Anticipated living arrangement for the child at the date of discharge; g. Anticipated educational arrangement for the child at the time of discharge; h. Anticipated date for discharge from treatment purchased for the child. i. A permanency goal for the child. 5. Monthly, Child Placement Agencies, TRCCFs, RCCFs and other contractor types other than PRTF, shall conduct a monthly review of each plan to evaluate whether the short-term and long-term goals have been achieved or not achieved. These parties shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, the Contractor agrees to sequence reports to be received by the County 15 calendar days prior to judicial or administrative hearings or reviews when provided with 30 calendar days advance notice of such dates by County. 6. Every 14 days, PRTFs shall provide the County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. SECTION IV - CONTRACTOR SHALL: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub -contract without the express written approval of the Director of the County Department or his/her appointed designee. 5 SS -23A revised 2/09 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs and $400,000 for PRTFs, TRCCFs, and RCCFs for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this contract in order to make reparations for any wrongful acts, omissions, or any other defalcations of the Contractor. 8. Indemnify County, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. Paragraphs 6, 7 and 8 do not apply to the University of Colorado contracts with county departments. 9. In regards to University of Colorado contractors only, the contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24- 10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. Contractor shall, in any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times the Contractor shall make home studies and related materials available to 6 SS -23A revised 2/09 the County for review, at a location agreed upon by the County and the Contractor, during regular business hours. 12. Bill the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for TRCCF and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs, CPAs and other contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within 30 calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with the Contractor pursuant to two (2) weeks written notice by the County. The Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. The Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. SECTION V - COUNTY SHALL: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. If this agreement covers an initial placement for a child, the Contractor may receive a clothing allowance in accordance with State Department rules. 6. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 7 SS -23A revised 2/09 7. Invite Contractor to Administrative Reviews at least 2 weeks prior to the scheduled review. 8. Involve Contractor in planning for the child and give the Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 9. The County shall seek recovery from the TRCCF, RCCF, CPA or other contractor type for any non Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the TRCCF, RCCF, CPA or other contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The TRCCF, RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10. The County shall identify the amount agreed upon with the Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 11. Reimbursement rates that are negotiated between the County and the Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. SECTION VI - GENERAL PROVISIONS 1. The Parties to this Agreement intend that the relationship between them, contemplated by this Agreement is that of employer —independent contractor. No agent, employee, or servant of Contractor shall be deemed to be an employee, agent, or servant of the County. Contractor will be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. 2. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. 3. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor will be released from responsibility for loss or damage to such personal items. 4. This Agreement is intended to be applied in conjunction with the child specific addendum and family services plan as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall 8 SS -23A revised 2/09 not be construed as either prohibiting the periodic amending of the family services plan or appending a county designed addendum to this agreement. 5. The contract shall permit the State Department to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other contracts as deemed necessary. The Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. A. All reimbursement requests shall be submitted to and approved by the appropriate County staff. Reimbursement for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Furthermore, Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this contract and shall also include Medicaid funds for PRTF and TRCCF therapeutic programs and CHRP placements paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Reimbursement requests for therapy costs for clients enrolled in PRTF, TRCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. The Contractor shall forward copies of such billings to the County on a monthly basis. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, the Contractor shall refund those dollars forthwith. B. The purpose of these requirements is to provide minimum assurance that the Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to the county departments of human/social services and Colorado Department of Human Services for the use of public funds. (1) The Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). The Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of the Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 9 SS -23A revised 2/09 (2) All billing by the contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. (3) All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If the Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, TRCCFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, TRCCFs and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after the contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this contract and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of the Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, the Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. (4) If Contractors do not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If the contractor is a CPA, then sanctions of the contractor may occur for failure to submit. (5) In cases where documentation does not exist to support audit information or services provided, contractor will be required to repay all funds received for which documentation does not exist. 10 SS -23A revised 2/09 (6) In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within 4 months of the date of the audit. (7) Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose fiscal sanctions, penalties, or cancel the contract. 6. In the event this contract is terminated, final payment to the Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to the Contractor due to omission, error, fraud, or misuse of funds shall be recovered from the Contractor either by deduction from subsequent payments under this contract or other contracts between the County and the Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Depai intent of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this contract or appropriate statutes and regulations. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. ATTEST: Weld County Clerk to the Board • 2%'�1_ Deputy Clerk to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: WELD COUNTY BOARD OF SOCIAL SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Chair Signature AU[7 ;" • CONTRACTOR Youthtrack 1375 Ken Pratt Blvd Loy gnront, CO 80501 1 By:-Crv/y\----// 11 SS -23A revised 2/09 lr9-/x'23' Hello