HomeMy WebLinkAbout20092632MEMORANDUM
Atari, DATE: September 30, 2009
TO: William F. Garcia, Chair, Board of County ommissioners
VIIDC 1C�i-
FROM- Judy A. Griego, Director, Human Services epartm
COLORADO RE:
Agreement to Purchase Out -of -Home Placement Services
between the Weld County Department of Human Services
and Various Providers for Consent Agenda
Request Board approval of Agreements to Purchase Out -of -Home Placement Services between
the Department and Various Providers. These Agreements were presented at the Boards April
27, 2009, Work Session. Please place on Consent Agenda.
The major provisions of these Agreements arc as follows.
No
Facility Name!
Term
Type of Facility/ Location
1 Arapahoe House
July I, 2009 — June 30, 2010
Ariel Child Placement Agency
July 1, 2009 — June 30, 2010
3 Bridges Inc.
July 1, 2009 — June 30, 2010
4 Commonworks D.B.A. Synthesis
July I, 2009 — June 30, 2010
Dale House Project
July 1, 2009 - June 30, 2010
6 Denver Area Youth Services
July 1, 2009 — June 30, 2010
7 Hope & Home
July 1, 2009 — June 30, 2010
8 Lost and Found Inc.
July I, 2009 June 30, 2010
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home Based After -Care
Thornton, Colorado
Child Placement Agency Services
Wheat Ridge, Colorado
Child Placement Agency Services
Pueblo, Colorado
Child Placement Agency Services
Child Residential Habilitation Program
Arvada, Colorado
Residential Child Care Facility
Colorado Springs, Colorado
Child Placement Agency Services
Denver, Colorado
Child Placement Agency Services
Colorado Springs, Colorado
Child Placement Agency Services
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home Based After -Care
Wheat Ridge, Colorado
Child Placement Agency Services
Fort Collins, Colorado
9
Lutheran Family Services of Colorado
July 1, 2009 — June 30, 2010
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2009-2632
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10
Maple Star Colorado
July 1, 2009 — June 30, 2010
Child Placement Agency Services
Group Home/Group Center Care
Denver, Colorado
11
Namaqua Center/LCMH
July 1, 2009 — June 30, 2010
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home-Based After -Care
Loveland, Colorado
12
Reflections For Youth, Inc.
July 1, 2009 - June 30, 2010
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home Based After -Care
Berthoud, Colorado
13
Savio House
July 1, 2009 - June 30, 2010
Child Placement Agency Services
Group Home/Group Center Care
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home Based After -Care
Denver, Colorado
14
Shiloh House
July 1, 2009 - June 30, 2010
Residential Child Care Facility
Therapeutic Residential Child Care Facility
Transition/Home Based After -Care
Littleton, Colorado
15
Special Kids Special Families
July 1, 2009 — June 30, 2010
Child Placement Agency Services
Colorado Springs, Colorado
16
Attention Homes
July 1, 2009 — June 30, 2010
Residential Child Care Facility
Shelter Home
Boulder, Colorado
17
Evergreen Group Center
July 1, 2009 — June 30, 2010
Group Home/Group Center Care
Longmont, Colorado
18
Frontier Family Services
July 1, 2009 — June 30, 2010
Child Placement Agency Services
Longmont, Colorado
19
Imagine
July 1, 2009 — June 30, 2010
Child Placement Agency Services
Child Residential Habilitation Program
Lafayette, Colorado
20
Roundup Fellowship
July 1, 2009 — June 30, 2010
Child Residential Habilitation Program
Residential Child Care Facility
Transition/Home Based After -Care
Denver, Colorado
21
Smith Agency, �i, tic .
July 1, 2009 — June 30, 2010
Child Placement Agency Services
Child Residential Habilitation Program
Group Home/Group Center Care
Residential Child Care Facility
Transition/Home Based After -Care
Centennial, Colorado
22
WhimSpire CPA
July 1, 2009 — June 30, 2010
Child Placement Agency Services
_ Montrose, Colorado
If you have questions, please give me a call at extension 6510.
COLORADO
DEPARTMENT OF HUMAN SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website: www.co.weld.co.us
Administration and Public Assistance (970) 352-1551
Child Support (970) 352-6933
MEMORANDUM
TO: Judy Griegol —Director
FROM: Lesley Cobt1-/Child Welfare Rate Negotiator
DATE: August 4, 2009
SUBJECT: 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:
1
2
3
4
5
6
7
8
9
Weld County
Out -of -Home Placement Providers
2009-2010
Arapahoe House
Ariel Child Placement Agency
Bridges Inc.
Commonworks D.B.A.
Synthesis
Dale House Project
Denver Area Youth Services
Hope & Home
Lost and Found Inc.
Lutheran Family Services of
Colorado
8801 Lipan St
4251 Kipling St, Unit 500
1225 N Main Street,
Suite 102
5310 Ward Road, Suite
G-01
7W Dale St
1530 W 13th Ave
1925 Dominion Way, Ste
200
6700 W 44th Ave
2032 Lowe Street, Suite
200
Thornton, CO 80260
Wheat Ridge, CO
80033-2899
Pueblo, CO 81003
Arvada, CO 80002
Colorado Springs, CO
80903
Denver, CO 80204-
2402
Colorado Springs, CO
80918
Wheat Ridge, CO
80033
Fort Collins, CO
80525
88692
90205
1980
104085
1502911
45069
29867
49489
45080
10 Maple Star Colorado
11 Namaqua Center/LCMH
12 Reflections For Youth, Inc.
13 Savio House
14 Shiloh House
15 Special Kids Special Families
2785 Speer Blvd, Suite
340
404 East 7th Street
PO Box 1860
325 King Street
6400 W Coal Mine Ave
424 W Pikes Peak Ave
Denver, CO 80211
Loveland, CO 80537
Berthoud CO 80513
Denver, CO 80219
Littleton, CO 80123
Colorado Springs, CO
80905
13416
1547532
1530130
1548844
1539982
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.
43184
COLORADO
DEPARTMENT OF HUMAN SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website: www.co.weld.co.us
Administration and Public Assistance (970) 352-1551
Child Support (970) 352-6933
MEMORANDUM
TO: Judy Griego — Director
FROM: Lesley Cobb - Child Welfare Rate Negotiator
DATE: September 10, 2009
SUBJECT: 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
1 Attention Homes
2 Evergreen Group Center
3 Frontier Family Services
4 Imagine
5 Roundup Fellowship
6 Smith Agency
7 WhimSpire CPA
3080 Broadway, Suite C
1436 Hilltop Dr.
1290 Boston Ave
1400 Dixon Ave
2250 S Oneida, Suite
201
7169 S. Liverpool St.
309 S Cascade Ave
Boulder, CO 80304
Longmont, CO 80501
Longmont, CO 80501-
5810
Lafayette, CO 80026
Denver, CO, 80224
Centennial, CO 80016
Montrose CO 81401
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
❑ 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 OII`\ between the Weld
County Department of Social/Human Services he after called "County" and
Arapahoe House, 8801 Lipan St, Thornton, CO 80260, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Arapahoe House.
?y
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
91009- 074,32
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
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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:
f
6-.
Deputy Clerk to the
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: 6
Chair Signature
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Arapahoe House
8801 Lipan St
Thornton, CO 80260
��ec u. rot Lkf t6P_F1�
11
SS -23A revised 2/09
aco9 • am3a
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):
Z;
THIS AGREEMENT, made this \ day of , � (� ,� between the Weld
County Department of Social/Human Services he ein er called "County" and Ariel
Child Placement Agency, 4251 Kipling St, Unit 500, Wheat Ridge, CO 80033-2899,
hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed
by the Weld County Department of Social/Human Services and Ariel Child Placement
Agency.
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
02009- 2/ 3a
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: 6.2,a
Deputy Clerk to
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
William F. Garcia (10/05/2009)
CONTRACTOR
Ariel Child Placement
Agency
4251 Kipling St, Unit 500
Wheat Ridge, CO 80033
3O3 - 703 g3 5�
11
SS -23A revised 2/09
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES
SS23A
® CHILD PLACEMENT AGENCY SERVICES (CPA)
❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP)
❑ 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 a,pdn between the Weld
County Department of Social/Human Services he i fMer called "County" and Bridges
Inc., 1225 N Main Street, Suite 102, Pueblo, CO 81003, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Bridges 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.
I
SS -23A revised 2/09
am9-02!032
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
I. 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
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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.
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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.
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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.
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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
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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.
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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
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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.
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(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.
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(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 Clerk to th
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: l
7
Chair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Bridges Inc.
1225 N Main Street,
Suite 102
Pueblo, CO 81003
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o7e09-ala3a
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 •eiti fter called "County" and
Commonworks D.B.A. Synthesis, 5310 Ward Road, Suite G-01, Arvada, CO 80002,
hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed
by the Weld County Department of Social/Human Services and Commonworks D.B.A.
Synthesis.
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.
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da09-,7432
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
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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.
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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.
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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.
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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
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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.
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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.
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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
ci
By: &- u'% a' -
Deputy Clerk to th
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
William F. Garcia (10/05/2009)
CONTRACTOR
Commonworks
D.B.A. Synthesis
5310 Ward Road, Suite G-01
Arvada, CO 80002
BY: a%iAtt-A.I DIJRR..
SS -23A revised 2/09
11 o2LO% 2%a32_
i1
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 h lei fter called "County" and Dale
House Project, 7 W Dale St, Colorado Springs, CO 80903, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Dale House Project.
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.
�S
7/.",
0
SS -23A revised 2/09
070aI-ae3a
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.
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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.
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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.
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(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.
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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 tp the Board
By:
Deputy Clerk to the Board j AI
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:
William F. Garcia (10/05/2009)
CONTRACTOR
Dale House Project
7 W Dale St
Colorado Springs, CO 80903
By:
SS -23A revised 2/09
I I 226'07_ 02(03,2.
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 ti IA, l { between the Weld
County Department of Social/Human Services hereinafter called "County" and Denver
Area Youth Services, 1530 W 13th Ave, Denver, CO 80204-2402, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Denver Area Youth 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.
2,
1
SS -23A revised 2/09
aooy-ato3a
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 tcimination.
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.
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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.
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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.
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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.
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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 maybe
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 Clerk to the
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 Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Denver Area Youth Services
1530 W 13th Ave
Denver, CO 80204-2402
11
SS -23A revised 2/09
01007. ,263,2,
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 her! in .(I' er called "County" and Hope &
Home, 1925 Dominion Way, Ste 200, Colorado Springs, CO 80918, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Hope & 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
019009-243.Z
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
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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.
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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 finds.
(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: di
Deputy Clerk to th- : oat* N
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 Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Hope & Home
1925 Dominion Way, Ste 200
Colorado Springs, CO 80918
By: .1 e / 11 qui
I1
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 l day of ep� between the Weld
her
County Department of Social/Human Services ma er called "County" and Lost and
Found Inc., 6700 W 44th Ave, Wheat Ridge, CO 80033, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Lost and Found 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
o?OO%-o?103.2
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
maybe 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: '_ 6
Deputy Clerk to the
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 Signature
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Lost and Found Inc.
6700 W 44th Ave
Wheat Ridge, CO 80033
an!
11
SS -23A revised 2/09
oWOO9._ ,243a-
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES
SS23A
❑ CHILD PLACEMENT AGENCY SERVICES (CPA)
❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP)
El 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 \ C,po9j between the Weld
County Department of Social/Human Services her ina er called "County" and Lutheran
Family Services of Colorado, 2032 Lowe Street, Suite 200, Fort Collins, CO 80525,
hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed
by the Weld County Department of Social/Human Services and Lutheran Family
Services 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.
J
1
SS -23A revised 2/09
02O0?-ae.,3a.
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.
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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.
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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.
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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.
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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: 6 4, By:
Deputy Clerk to t
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
SS -23A revised 2/09
WELD COUNTY BOARD
OF SOCIAL SERVICES,
ON BEHALF OF THE
WELD COUNTY
DEPARTMENT OF
HUMAN SERVICES
Chair ignature
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Lutheran Family Services
of Colorado
2032 Lowe -Street to -200
Fe#-C-ollins, CO 80525'
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sD �T T e ACS
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AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES
SS23A
® CHILD PLACEMENT AGENCY SERVICES (CPA)
❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP)
® 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 0O between the Weld
County Department of Social/Human Services h ei fter called "County" and Maple
Star Colorado, 2250 S Oneida Street, Suite 100, Denver, CO 80224-2557, hereinafter
called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Maple Star 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.
1
SS -23A revised 2/09
0700?- a(o3.
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.
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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.
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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
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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 Depaitnient 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.
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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.
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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 maybe
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 Clerk to
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 S : VICES
Chair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Maple Star Colorado
2250 S Oneida Street,
Suite 100
Denver, CO 80224-2557
By:
SS -23A revised 2/09
11 v71X19_a(a37.
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)
Et RESIDENTIAL CHILD CARE FACILITY (RCCF)
❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM
❑ SHELTER CARE
❑ SUBSIDIZED ADOPTION
Z THERAPEUTIC RESIDENTIAL CHILD CARE FACILITY (TRCCF)
Z TRANSITION/HOME BASED AFTER -CARE (RCCF)
❑ OTHER (DESCRIBE):
THIS AGREEMENT, made this \ day of flu , C139 between the Weld
County Department of Social/Humah Services her in fter called "County" and
Namaqua Center/LCMH, 404 East 7th Street, Loveland, CO 80537, hereinafter
called "Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Namaqua Center/LCMH.
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.
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SS -23A revised 2/09
on9- a43a
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 to ination.4I unless r A.sic- pow,-- O-w•or c n
Iw\withe-vs-ntsk \0 S44 -o,— a ( J
3. This Agreement is in lieu of and supersedes all prior agree i3 b tween
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
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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.
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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.
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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.
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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
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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.
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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.
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(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.
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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
LAW
By: c' -
Deputy Clerk to
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
William F. Garcia (10/05/2009)
CONTRACTOR
Namaqua Center/LCMH
404 East 7th Street
Loveland, CO 80537
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oQOO j- o263,2-
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)
E 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 1 day of 1 ,2c°� between the Weld
County Department of Social/Human Services h eih ei after called and
Reflections For Youth, Inc., PO Box 1860, Berthoud CO 80513, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Reflections For Youth, 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.
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SS -23A revised 2/09
07O09 -a63.2_
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
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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.
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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.
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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.
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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.
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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.
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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 Depai Intent 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:
YLPL4//G
Deputy Clerk to th
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
LG(
Chair Signature
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Reflections For Youth, Inc.
PO Box 1860
Berthoud CO 80513
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)
® 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 aoc1 between the Weld
County Department of Social/Human Services he in tter called "County" and Savio
House, 325 King St, Denver, CO 80219, hereinafter called "Contractor." THIS
AGREEMENT, shall include all children placed by the Weld County Department of
Social/Human Services and Savio 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.
I
SS -23A revised 2/09
aoo9_,263a,
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 -I33, 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 Clerk to the B
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
N
1.
hair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Savio House
325 King St
Denver, CO 80219
O
By:
SS -23A revised 2/09
11 avo9...a&5a
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 20 between the Weld
County Department of Social/Human Services he i fter called "County" and Shiloh
Home, 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter called "Contractor."
THIS AGREEMENT, shall include all children placed by the Weld County Department
of Social/Human Services and Shiloh 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.
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SS -23A revised 2/09
O7OO9_ .243a
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
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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.
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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.
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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.
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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
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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.
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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
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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.
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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.
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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
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
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Shiloh Home
6400 W Coal Mine Ave
Littleton, CO 80123
cj
even E. Ramir- z CEO
SS -23A revised 2/09
11 0200f.X32
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 7 between the Weld
County Department of Social/Human Services he er called "County" and Special
Kids Special Families, 424 W Pikes Peak Ave, Colorado Springs, CO 80905,
hereinafter called "Contractor." THIS AGREEMENT, shall include all children placed
by the Weld County Department of Social/Human Services and Special Kids Special
Families.
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.
A(.
1
SS -23A revised 2/09
ac9-a1o3a.
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.
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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.
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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
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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.
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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.
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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
/Clto
erk t000 the Board
Jrnellgli
Bi By:
Deputy Clerk to
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
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Special Kids Special Families
424 W Pikes Peak Ave
Colorado Springs, CO 80905
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SS -23A revised 2/09
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES1g9 SFP 1l: 23
SS23A
❑ CHILD PLACEMENT AGENCY SERVICES (CPA)
❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP)
❑ 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 •ei ftec called "County" and Attention
Homes, 3080 Broadway, Suite C, Boulder, CO 80304, hereinafter called "Contractor."
THIS AGREEMENT, shall include all children placed by the Weld County Department
of Social/Human Services and Attention Homes.
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
ac09- 263z
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.
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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.
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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.
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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
O)44/Au
By: G ci.jo7i
Deputy Clerk to the
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
William F. Garcia (10/05/2009)
By:
CONTRACTOR
Attention Homes
3080 Broadway, Suite C
Boulder, CO 80304
II
SS -23A revised 2/09
aOO9-243a
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES lolly fill)
SS23A fill,
25
116
❑ CHILD PLACEMENT AGENCY SERVICES (CPA)
❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP)
Z 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 a q day of CLug us' ,jooq between the Weld
County Department of Social/Human Services hereinafter called "County" and
Evergreen Group Center, 1436 Hilltop Dr., Longmont, CO 80501, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Evergreen Group 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.
SS -23A revised 2/09
1 aoo9--02/03_
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.
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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 t
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
Chair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Evergreen Group Center
1436 Hilltop Dr.
Longmont, CO 80501
By j,c41_viJLLCA-. 044)
11
SS -23A revised 2/09
,2ee0y_2G3a
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 o2ir+ between the Weld
County Department of Social/Human Services hfter called "County" and Frontier
Family Services, 1290 Boston Ave, Longmont, CO 80501-5810, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Frontier 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.
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
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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.
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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.
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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 maybe
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: Goo G�zz
Deputy Clerk to the
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
William F. Garcia (10/05/2009)
CONTRACTOR
Frontier Family Services
1290 Boston Ave
Longmont, CO 80501-5810
SS -23A revised 2/09
11 aot°y-21o3a
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 between the Weld
County Department of Social/Human Services he i er called "County" and Imagine,
1400 Dixon Ave, Lafayette, CO 80026, hereinafter called "Contractor." THIS
AGREEMENT, shall include all children placed by the Weld County Department of
Social/Human Services and Imagine.
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
aO:79-3.2
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
I. 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 Clerk to the
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: v(
Chair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Imagine
1400 Dixon Ave
Lafayette, CO 80026
By:
SS -23A revised 2/09
11 02009-.2/03.7—.
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES
SS23A
S c
❑ CHILD PLACEMENT AGENCY SERVICES (CPA)
Z 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 L�J d009 between the Weld
County Department of Social/Human Services hAfediafter called "County" and Roundup
Fellowship, 2250 S Oneida, Suite 201, Denver, CO, 80224, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Roundup Fellowship.
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.
7
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 maybe 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.
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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.
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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.
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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
;Q/
By:.
Deputy Clerk to
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: ogli
'l
air Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Roundup Fellowship
2250 S Oneida, Suite 201
Denver, CO, 80224
11
SS -23A revised 2/09
az09-,2/03.2.
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES
SS23A
® CHILD PLACEMENT AGENCY SERVICES (CPA) re NIG 26
CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP) RR 11 13
® 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`Opg between the Weld
County Department of Social/Human Services her er called "County" and Smith
Agency Inc., 7169 S Liverpool St, Centennial, CO 80016, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and Smith Agency.
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
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 maybe 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.
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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
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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.
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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.
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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.
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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
B
WELD COUNTY BOARD
OF SOCIAL SERVICES,
ON BEHALF OF THE
WELD COUNTY
DEPARTMENT OF
HUMAN SERVICES
By:
Chair Signature
William F. Garcia (10/05/2009)
CONTRACTOR
Smith Agency Inc.
7169 S Liverpool St
Centennial, CO 80016
By: (1 MS.
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Pr° to inn Ad en tn/P(acrbvvuut±Di r.
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SS -23A revised 2/09
%o% 263x.
AGREEMENT TO PURCHASE
OUT -OF -HOME PLACEMENT SERVICES s"" —
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❑ 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 eine er called "County" and
WhimSpire CPA, 309 S Cascade Ave, Montrose, CO 81401, hereinafter called
"Contractor." THIS AGREEMENT, shall include all children placed by the Weld
County Department of Social/Human Services and WhimSpire CPA.
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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.
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SS -23A revised 2/09
ace9-24732
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
maybe 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
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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.
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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.
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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.
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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.
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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
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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.
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(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.
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(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 Clerk to th
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: (ii /
Chair Signature
William F. Garcia (10/05/2009)
By:
CONTRACTOR
WhimSpire CPA
309 S Cascade Ave
Montrose, CO 81401
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SS -23A revised 2/09
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