HomeMy WebLinkAbout20091475.tiffMEMORANDUM
ICY
DATE: June 11, 2009
TO: William F. Garcia, Chair, Board of County ommissi er
CFROM: Judy A. Griego, Director, Human Services epaftm t rh"
COLORADO RE: Addendum to the Individual Provider Contract for Purpose of
Foster Care Services and Foster Care Facility Agreements
between the Weld County Department of Human Services
and Various Providers for Consent Agenda
Enclosed for Board approval is an Addendum to the Individual Provider Contract for Purpose of
Foster Care Services and Foster Care Facility Agreements between the Department and Various
Providers. These Agreements were presented at the Board's June 8, 2009, Work Session.
The major provisions of these Agreements are as follows:
No.
Facility Name/
Term
Type of Facility/
Location
Daily Rate
1
Kohler, Christopher and
Vance, Michelle
May 18, 2009 —June 30, 2009
Foster Home
Firestone, Colorado
$16.32 - $40.11
2
Steele, Dana and Cassandra
July 1, 2008 — August 30, 2009
Foster Home
Johnstown, Colorado
$16.32 - $40.11
If you have any questions, give me a call at extension 6510.
2009-1475
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WELD COUNTY ADDENDUM
To that certain Individual Provider Contract for Purpose of Foster Care
Services and Foster Care Facility Agreement (the "Agreement") between
CHRISTOPHER KOHLER & MICHELLE VANCE
and the
Weld County Department of Human Services
for the period from T ry I f ,txr'i through June 30, 2009.
The following provisions, made this 1 S1/-� day of Ma -C- 2009, are added to the
referenced Agreement. Except as modified hereby, all terms o the Agreement remain
unchanged.
GENERAL PROVISIONS
County and Provider agree that a child specific Needs Based Care Assessment,
designated as Attachment B, shall be used to determine levels of care for each child
placed with Provider unless the child is placed in a County certified kinship foster care
home or if the child is placed in a County foster/adoption home as a pre -adoptive
placement. Kinship foster care homes and pre -adoptive placements will be reimbursed at
the County Basic Maintenance level on the Needs Based Care Rate Table, designated as
Attachment C, regardless of the child's level of need.
2. County agrees to purchase and Provider agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the Weld County Certified Foster Care Home identified as Provider
ID#1556593. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Department Administrator before payment will
be release to Provider.
4. Any additional costs for specialized services, which may include but are not limited to;
Co -pays, deductibles, or services not covered by Medicaid, will need to be authorized, in
writing by the Department Administrator, prior to the service being performed. Any
payment for specialized services not authorized in writing may be denied.
5. All reimbursement requests shall be submitted to and approved by the appropriate County
staff as set forth in the Foster Parent Handbook. Reimbursement for placement services
shall be paid from the date of placement up to, but not including the day of discharge. All
billings by the Provider must be in a format approved by the County and may be returned
unpaid if submitted in an unapproved format or inadequate documentation is provided.
All billings are to be submitted by the 4th of each month following the month of service.
If the billing is not submitted within twenty-five (25) calendar days of the month
following service, it may result in forfeiture of payment.
ay_o9
Weld County Addendum to the CWS-7A
6. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Provider substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Provider until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the Provider
cannot be performed or if performed would be of no value to the Human Services.
Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
C. Recover from the Provider any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Provider, or by Human
Services as a debt to Human Services or otherwise as provided by law.
7. Provider shall promptly notify Human Services in the event in which it is a party
defendant or respondent in a case, which involves services provided under the agreement.
The Provider, within five (5) calendar days after being served with a summons,
complaint, or other pleading which has been filed in any federal or state court or
administrative agency, shall deliver copies of such document(s) to the Human Services'
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
PROVIDER AGREES:
1. To attend or participate, if requested by the Department, in staffing a child's placement
with the Utilization Review Team. This review team convenes every Monday morning,
excluding holidays but may hold emergency staffings as needed.
2- To request a staffing if considering giving notice to remove a child, except in emergency
situations. These requests shall be made through the child's caseworker and/or the
provider's Foster Home Coordinator.
3. To cooperate with any contractors hired by Weld County Department of Human Services
or Weld County Department of Human Services staff to preserve placement in the least
restrictive placement appropriate and to comply with the treatment plan of the child.
4. To schedule physical and dental examinations within 48 hours after a child is placed in
provider's care. Medical examinations need to be completed within 10 days of the child
being placed with Provider and dental examinations need to be completed within 14 days
of the child being placed with Provider. All documentation of these examinations will be
placed in the Foster Child's Placement Information Management Binder or as indicated
in the Foster Parent Handbook.
5. To attend all necessary school meetings and support any plan that is developed regarding
the child in order to promote educational success.
2
Weld County Addendum to the CWS-7A
6. To read, be familiar with and agree to the terms and conditions as set forth in the Foster
Parent Handbook.
7. To report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set fourth in Section 19-3-304, C.R.S.
8. To maintain/access information on the Foster Parents Internet Database On-line System
(FIDOS) as indicated in the Foster Parent Handbook.
9. To maintain/update information in the Foster Child Placement Information Management
binder. The binder may be reviewed on a monthly basis and signed off by child's
caseworker and/or the provider's Foster Home Coordinator.
10. To maintain behavior observation notes as required by the level of care assessed for each
child as indicted in the Foster Parent Handbook.
EXHIBITS: (Please refer to pages 4-7)
3
Weld County Addendum to the CWS-7A
IDENTIFYING INFORMATION _
CIIILD'S NAME
WORKER COMPLETING ASSESSMENT
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
STATE ID#
HIV/
SEX [TRAILS CASE II) DOB
M F
DATE OF ASSESSMENT
AGENCY NAME
PROVIDER NAME
PROVIDER TRAILS ID
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT
• For each question below, please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following: Therapy; Medical Treatment;
Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan?
❑Basic Maint.) Less than one round trip a week
❑2) 3-4 round trips a week.
❑3'/) 7 round trips or more
❑ 1) One round trip a week El 1/2) 2 round trips a week
❑2'/,) 5 round trips a week ❑3) 6 round trips a week
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑ Basic Maint.) No participation required
❑2) Three times a month
❑3%) Three times a week or more
❑l) Once a month ❑1%) Two times month
❑2'/:) Once a week E3) Two times a week
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular or
special education plan?
❑ Basic Maint.) No educational requirements
❑2) 1 hour a day
❑3'A) More that 3 hours per day
❑1) Less than a % hour per day 011/2) % hour a day
❑2' 'A) 1'h-2 hours per day ❑3) 2'/z-3 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
❑ Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week ❑1'/:) 5 to 7 hours per week
❑2) 8 to 10 hours per week EVA) 11 to 14 hours per week
❑ 3) Constant basis during awake hours ❑3%:) Nighttime hours
P 5. How much time is the provider required to assist the child because of impairments beyond ate appropriate needs with feeding,
bathing, grooming, physical, and/or occupational therapy?
❑ Basic Maint.) 0-2 hours per week ❑1) 3 to 4 hours per week El %) 5 to 7 hours per week
E2) 8 to 10 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week
❑3'/:) 21 or more hours per week
A 1. How often is CPA/County case management required? (Does not include therapy)
❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention.
(i.e. mutual care placements.)
El) Face-to-face contact one time per month with child and minimal crisis intervention.
❑ 1'%) Face-to-face contact one time per month with child and occasional crisis intervention.
❑2) Face-to-face contact two times per month with child and occasional crisis intervention.
❑ 2'h) Face-to-face contact three times per month with child and occasional crisis intervention.
❑3) Face-to-face contact weekly with child and occasional crisis intervention.
❑3%:) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination
of multiple services.
**Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one
County foster child is with the same provider.
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
❑0) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month
❑2) 4-8 hours per month ❑3) 9-12 hours per month
4
Weld County Addendum to the CWS-7A
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Assessment Areas
one
0
Rating of Conditions
(Check one box for each category)
Mild
1
Moderate
2
Severe
3
Aggression/Cruelty to Animals
Verbal or Physical Threatening
o
Destructive of Property/Fire
Setting
Stealing
Self -injurious Behavior
Substance Abuse
Presence of Psychiatric
Symptoms/Conditions
Enuresis/Encopresis
o
Runaway
Sexual Offenses
5
Weld County Addendum to the CWS-7A
BEHAVIOR ASSESSMENT CONTINUED
(Exhibit B)
Inappropriate Sexual Behavior
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Rating of Conditions
(Check one box for each category)
None !Wild Moderate
0 1 2
Disruptive Behavior
Delinquent Behavior
Depressive -like Behavior
Medical Needs
(If condition is rated "severe", please complete
the Medically fragile NBC)
Emancipation
Eating Problems
Boundary Issues
Requires Night Care
Education
Involvement with Child's Family
CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT:
(check level of need) ❑ 0 ❑ 1 ❑ 2 ❑ 3
6
Weld County Addendum to the CWS-7A
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
LEVEL OF
SERVICE
RECOMMENDED
PROVIDER RATE
P1 -P5
Level
Rate
County Basic
Maint.
Age 0-10...$16.32/day ($496/month)
Age 11-14...$18.05/day ($549/month)
Age 15-21...$19.27/day ($586/month)
+ Respite Care $.66/day ($20/month)
1
$19.73
+$.66 Respite Care
Total Rate = ($20.39 day/$620 month)
1 1/2
$23.01
+$.66 Respite Care
Total Rate = ($23.67 day/$720 month)
2
$26.30
+$ 66 Respite Care
Total Rate = ($26.96 day/$820 month)
2 1/2
$29.59
+$.66 Respite Care
Total Rate = ($30.25 day/$920 month)
3
$32.88
+$.66 Respite Care
Total Rate = ($33.54day/$1020 month)
3 1/2
$36.16
+$.66 Respite Care
Total Rate = ($36.82 day/$1,120 month)
4
TRCCF Drop Down
$39.45
+$.66 Respite Care
Total Rate = ($40.11 day/$1220 month)
'itt'4!;7:1;!;!41114 .:.... a:E
a.
•013! 11';:!:".,::•:, . ........i..� �� .. _:ry oL
Assessment Rate
(30 day max)
$30.25 day/$920 month (Includes Respite)
Effective 7/1/2008
7
Weld County Addendum to the CWS-7A
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
By:
gailidamt
Weld County C
pm,
WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By:
Deputy Gl'erk to the Board Chair Signature
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
William F. Garcia
JUN 2 4 2009
PROVIDER:
Chris Kohler & Michelle Vance
10515 Cimmarron St.
Firestone, Colorado 80504
By:
(Signature).
8
Weld County Addendum to the CWS-7A
WELD COUNTY ADDENDUM
To that certain Individual Provider Contract for Purpose of Foster Care
Services and Foster Care Facility Agreement (the "Agreement") between
Steele, Dana and Cassandra
and the
Weld County Department of Human Services
for the period from July 1, 2008 through June 30, 2009.
The following provisions, made this _2(0 day of 1r , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of tement remain unchanged.
GENERAL PROVISIONS
1. County and Provider agree that a child specific Needs Based Care Assessment,
designated as Attachment B, shall be used to determine levels of care for each child
placed with Provider unless the child is placed in a County certified kinship foster care
home or if the child is placed in a County foster/adoption home as a pre -adoptive
placement. Kinship foster care homes and pre -adoptive placements will be reimbursed at
the County Basic Maintenance level on the Needs Based Care Rate Table, designated as
Attachment C, regardless of the child's level of need.
2. County agrees to purchase and Provider agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the Weld County Certified Foster Care Home identified as Provider
ID#1551234. These services will be for children who have been deemed eligible for
social services under the statutes, rules and regulations of the State of Colorado.
3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Department Administrator before payment will
be release to Provider.
4. Any additional costs for specialized services, which may include but are not limited to;
Co -pays, deductibles, or services not covered by Medicaid, will need to be authorized, in
writing by the Department Administrator, prior to the service being performed. Any
payment for specialized services not authorized in writing may be denied.
5. All reimbursement requests shall be submitted to and approved by the appropriate County
staff as set forth in the Foster Parent Handbook. Reimbursement for placement services
shall be paid from the date of placement up to, but not including the day of discharge. All
billings by the Provider must be in a format approved by the County and may be returned
unpaid if submitted in an unapproved format or inadequate documentation is provided.
All billings are to be submitted by the 4'h of each month following the month of service.
If the billing is not submitted within twenty-five (25) calendar days of the month
following service, it may result in forfeiture of payment.
„ co y - /y%
i�-ay-09
Weld County Addendum to the CWS-7A
�� `) (C .7 e /ie0(41)
6. The Director of Human Services or designee may exercise the following remedial actions
should s/he find that the Provider substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Provider until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the Provider
cannot be performed or if performed would be of no value to the Human Services.
Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
C. Recover from the Provider any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Human Services and the Provider, or by Human
Services as a debt to Human Services or otherwise as provided by law.
7. Provider shall promptly notify Human Services in the event in which it is a party
defendant or respondent in a case, which involves services provided under the agreement.
The Provider, within five (5) calendar days after being served with a summons,
complaint, or other pleading which has been filed in any federal or state court or
administrative agency, shall deliver copies of such document(s) to the Human Services'
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
PROVIDER AGREES:
1. To attend or participate, if requested by the Department, in staffing a child's placement
with the Utilization Review Team. This review team convenes every Monday morning,
excluding holidays but may hold emergency staffings as needed.
2. To request a staffing if considering giving notice to remove a child, except in emergency
situations. These requests shall be made through the child's caseworker and/or the
provider's Foster Home Coordinator.
3. To cooperate with any contractors hired by Weld County Department of Human Services
or Weld County Department of Human Services staff to preserve placement in the least
restrictive placement appropriate and to comply with the treatment plan of the child.
4. To schedule physical and dental examinations within 48 hours after a child is placed in
provider's care. Medical examinations need to be completed within 10 days of the child
being placed with Provider and dental examinations need to be completed within 14 days
of the child being placed with Provider. All documentation of these examinations will be
placed in the Foster Child's Placement Information Management Binder or as indicated
in the Foster Parent Handbook.
5. To attend all necessary school meetings and support any plan that is developed regarding
the child in order to promote educational success.
2 Weld County Addendum to the CWS-7A
6. To read, be familiar with and agree to the terms and conditions as set forth in the Foster
Parent Handbook.
7. To report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set fourth in Section 19-3-304, C.R.S.
8. To maintain/access information on the Foster Parents Internet Database On-line System
(FIDOS) as indicated in the Foster Parent Handbook.
9. To maintain/update infornation in the Foster Child Placement Information Management
binder. The binder may be reviewed on a monthly basis and signed off by child's
caseworker and/or the provider's Foster Home Coordinator.
10. To maintain behavior observation notes as required by the level of care assessed for each
child as indicted in the Foster Parent Handbook.
EXHIBITS: (Please refer to pages 4-7)
3
Weld County Addendum to the CWS-7A
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
IDENTIFYING INFORMATION
CHILD'S NAME
-olx�+ C-CLmtrt
WORKER COMPLETING ASSESSMENT
STATE ILO( -,
H Hq
(M, F
ITFtAILS CASE ID !DOB
fi "OS/
DATE OF ASSESSMENT
AGENCY NAME
PROVIDER NAME
PROVIDER TRAILS ID
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT
• For each question below, please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following: Therapy; Medical Treatment;
Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan?
❑Basic Maint.) Less than one round trip a week
02) 3-4 round trips a week.
❑3%) 7 round trips or more
01) One round trip a week 011/2) 2 round trips a week
❑2%) 5 round trips a week 03) 6 round trips a week
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑ Basic Maint.) No participation required
02) Three times a month
❑3%) Three times a week or more
01) Once a month ❑1'%) Two times month
❑2%) Once a week 03) Two times a week
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular or
special education plan?
❑ Basic Maint.) No educational requirements
02) 1 hour a day
03%) More that 3 hours per day
01) Less than a 'h hour per day 011/2) '/z hour a day
02 Y) 11/2-2 hours per day 03) 21/2-3 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
0 Basic Maint.) No special involvement needed
❑2) 8 to 10 hours per week
0 3) Constant basis during awake hours
01) Less than 5 hours per week
❑2%) I 1 to 14 hours per week
03%) Nighttime hours
❑ 1'/) 5 to 7 hours per week
P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feeding,
bathing, grooming, physical, and/or occupational therapy?
❑ Basic Maint.) 0-2 hours per week ❑1) 3 to 4 hours per week ❑1%) 5 to 7 hours per week
02) 8 to 10 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week
❑3%) 21 or more hours per week
A 1. How often is CPA/County case management required? (Does not include therapy)
['Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention.
(i.e. mutual care placements.)
01) Face-to-face contact one time per month with child and minimal crisis intervention.
❑1'%) Face-to-face contact one time per month with child and occasional crisis intervention.
❑2) Face-to-face contact two times per month with child and occasional crisis intervention.
❑2%) Face-to-face contact three times per month with child and occasional crisis intervention.
❑3) Face-to-face contact weekly with child and occasional crisis intervention.
❑3%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination
of multiple services.
**Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one
County foster child is with the same provider.
L 1. How often are therapy services needed to address child's individual needs per NBC assessment?
❑0) Not needed or provided by another source (i.e. Medicaid)
02) 4-8 hours per month
4
01) Less than 4 hours per month
❑3) 9-12 hours per month
Weld County Addendum to the CWS-7A
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that ay to this child.
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Aggression/Cruelty to Animals
0
❑
■
•
Verbal or Physical Threatening
❑
❑
❑
❑
Destructive of Property/Fire
Setting
❑
❑
❑
■
Stealing
❑
❑
❑
❑
Self -injurious Behavior
❑
❑
❑
1
Substance Abuse
0
0
❑
❑
Presence of Psychiatric
Symptoms/Conditions
❑
❑
❑
•
Enuresis/Encopresis
❑
❑
❑
❑
Runaway
❑
❑
❑
■
Sexual Offenses
❑
❑
❑
•
5
Weld County Addendum to the CWS-7A
BEHAVIOR ASSESSMENT CONTINUED
(Exhibit B)
Please rate the behavior/intensity of conditions which create the need for services that apply to this child,
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Inappropriate Sexual Behavior
❑
❑
0
❑
Disruptive Behavior
❑
❑
❑
■
Delinquent Behavior
❑
❑
❑
❑
Depressive -like Behavior
❑
❑
❑
❑
Medical Needs
(If condition is rated "severe". please complete
the Medically fragile NBC)
❑
❑
❑
•
Emancipation
❑
❑
❑
❑
Eating Problems
❑
❑
❑
0
Boundary Issues
0
❑
❑
1111
Requires Night Care
❑
❑
❑
❑
Education
❑
❑
❑
•
Involvement with Child's Family
❑
❑
❑
❑
CHILD'S OVERALL
(check level of
LEVEL OF NEED FROM BEHAVIOR ASSESSMENT:
need) ❑ 0 ❑ 1 ❑ ? ❑ 3
6
Weld County Addendum to the CWS-7A
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
Age 0-10...$16.32/day ($496/month)
County Basic
Maint.
1
Age 11-14...$18.05/day ($549/month)
Age 15-21...$19.27/day ($586/month)
+ Respite Care $.66/day ($20/month)
$19.73
+$.66 Respite Care
Total Rate = ($20.39 day/$620 month)
1 1/2
$23.01
4.66 Respite Care
Total Rate = ($23.67 day/$720 month)
2
$26.30
4.66 Respite Care
Total Rate = ($26.96 day/$820 month)
2 1/2
$29.59
+$.66 Respite Care
Total Rate = ($30.25 day/$920 month)
3
$32.88
+$.66 Respite Care
Total Rate = ($33.54day/$1020 month)
3 1/2
$36.16
+$.66 Respite Care
Total Rate = ($36.82 day/$1,120 month)
4
TRCCF Drop Down
$39.45
4.66 Respite Care
Total Rate = ($40.11 day/$1220 month)
Assessment Rate
(30 day max)
$30.25 day/$920 month (Includes Respite)
Effective 7/1/2008
Weld County Addendum to the CWS-7A
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
By:
MiaLL
Weld County
o the Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By:
Chair Signature
William F. Garcia
JUN 2 4 2009
PROVIDER:
Steele, Dana and Cassandra
324 Fossil Dr.
Johnstown, CO 80534
By:
(Signature)
8
Weld County Addendum to the CWS-7A
r Oo9 , /Y75.
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