HomeMy WebLinkAbout20082125.tiff RESOLUTION
RE: APPROVE STANDARD FORM FOR ADDENDUM TO AGREEMENT TO PURCHASE
CHILD PLACEMENT AGENCY SERVICES BETWEEN THE WELD COUNTY
DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board, sitting as the Weld County Board of Social Services, has been
presented with the form of an Addendum to the Agreement to Purchase Child Placement Agency
Services between the Weld County Department of Human Services and various providers, and
WHEREAS, after review, the Board deems it advisable to approve the form of said
addendum to said agreement, a copy of which is attached hereto and incorporated herein by
reference, and to delegate standing authority to the Chair of the Board of County Commissioners
to execute individual agreements between the Department of Human Services and various
providers.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, sitting as the Weld County Board of Social Services, that the form of the
Addendum to the Agreement to Purchase Child Placement Agency Services between the Weld
County Department of Human Services and various providers be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign any agreements consistent with the form of said addendum to said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 6th day of August, A.D., 2008.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
r
ATTEST: Aggiti
18
C7" '�' am H. Jerke, Chair
Weld County Clerk to the �� � I1�/l
(��l g
\ ' �?) Robert-D. Masden, Pro-Tem
BY:
Deputy Clerk o the Board / L
Wrcia
APP AS TO •
41\i/
David E. Long
un y A ey
ou as Radema er
Date of signature: (9,O/O617
2008-2125
HR0079
(�0 '. (-( S oE/�s%c��
6 DEPARTMENT OF HUMAN SERVICES
P.O. BOX A
GREELEV, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
111k
COLORADO MEMORANDUM
TO: Judy Griego- Director
FROM: Lesley Cobb -Child Welfare Contract
Negotiator
DATE: August 28, 2008
SUBJECT: Out-of-home providers to be submitted to the
Board of County Commissioner for Consent.
Attached please find a list of out-of-home providers that I am requesting to be submitted to the
Board of County Commissioner for their consent.
Directory:
Attachment I—RCCF/TRCCF Providers
Rates are based on the State Standard rates(also known as base anchor rates).The provider
received a 1.5%COLA,as set forth in the 08-09 Longbill and approved by the Board of Weld
County Commissioners.
Attachment II—County Certified Foster Care Providers
Rates are Based the Needs Based Care Assessment and rate table as approved by the Board of
Weld County Commissioners.
Attachment III—Child Placement Agency Providers
Rates are Based the Needs Based Care Assessment and rate table as approved by the Board of
Weld County Commissioners.
Attachment IV—RCCF/CHRP Providers
Rates are based on a negotiated rate per agency due to highly specialized care for children who are
not eligible or who are awaiting approval for CHAP.
Attachment V—Specialized Group Homes
Rates are based on the approved rate structure as outlined in DHS policy/procedures manual
section 2.308.5.
**To be submitted for approval as contracts arrive:
Group Centers/CPA—Due to varied rates based on negotiation with each agency/center. 2008-2125
RCCF only providers—Due to varied rates based on negotiation with each facility,this includes
out of State providers.
2008-2009 CONTRACTED
CPA PROVIDERS
CPA NAME FACILITY ID MAILING ADDRESS CITY STATE ZIP
Adoption Alliance 71259 2121 S.Oneda St, Suite 420 Denver, CO 80224
Adoption Options 45078 13900 E Harvard Ave, Suite 200 Aurora, CO 80014
Ariel Child Placement Agency 90205 4251 Kipling St, Unit 500 Wheat Ridge,CO 80033-2899
Bethany Christian Services 45514 4820 Rusina Rd,Suite C Colorado Springs, CO 80907-8127
Bridges Inc. 1980 1225 N Main Street, Suite 102 Pueblo, CO 81003
Commonworks D.B.A. Synthesis 104085 3000 Youngfield Street, Suite 155 Lakewood CO 80215
Dungarvin Colorado, Inc. 98960 4704 Harlan St.,Suite 200 Denver CO 80212-7417
Frontier Family Services 38041 1290 Boston Ave Longmont,CO 80501-5810
Hope&Home 29867 1925 Dominion Way,Ste 200 Colorado Springs, CO 80918
Hope Family Services 42942 1610 29th Ave Place#100 Greeley, CO 80634
Imagine 21369 1400 Dixon Ave Lafayette, CO 80026
Kids Crossing 79752 1440 E Fountain Blvd Colorado Springs,CO 80910-3502
Lost and Found Inc. 57351 6700 44th Ave Wheatridge, CO 80033
Loving Homes Inc. 72767 125 S Union Ave Pueblo CO 81003
Lutheran Family Services 45080 3800 Automation Way, Suite 200 Fort Collins, CO 80525
Maple Star Colorado 90967 2785 Speer Blvd, Suite 340 Denver, CO 80211
REM Colorado, Inc. 37832 4815 List Dr, Suite 111 Colorado, Springs CO 80919-3340
Savio House 37330 325 King Street Denver, CO 80219
Smith Agency Inc. 44882 7169 S Liverpool St Centennial, CO 80016
Special Kids Special Families 43184 424 W Pikes Peak Ave Colorado Springs,CO 80905
Youth Ventures of Colorado 1529601 4785 Granby Cir Colorado Springs, CO 80919
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Child Placement Agency Services
(the "Agreement") between «CPA_NAME» and Weld County Department of
Human Services for the period from
July 1, 2008 through June 30, 2009.
The following provisions, made this day of , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
1. County and Contractor 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 Contractor.
2. County agrees to purchase and Contractor 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 CPA identified as Provider ID#«FACILITY_ID». 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. Section I, Paragraph 2. 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. Add Paragraph 6 to Section I. A minimum of one polygraph test per Colorado fiscal
year, if needed by the child, will be furnished under this contract for facilities that
provide sex offender treatment.
5. Add Paragraph 7 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
which are not provided within the negotiated provider rate, will need to be authorized, in
writing by the County, prior to the service being performed. Any payment for specialized
services not authorized in writing will be denied.
6. Add Paragraph 5 to Section II. Contact by the Contractor with the County regarding
emergency medical, surgical or dental care will be made in person-to-person
communication, not through phone mail messages. During regular work hours, the
Contractor will make every effort to notify the assigned caseworker, supervisor, or intake
screener of any emergency medical, surgical or dental issues prior to granting
authorization. During non-regular work hours, weekends and holidays, the Contractor
will contact the Emergency Duty Worker at the pager number(970) 304-2749.
7. Section III, Paragraph 5. Contractor additionally agrees to have appropriate personnel
available for staffing current placements with the Utilization Review Team. This review
team convenes every Monday morning, excluding holidays.
8. Add Paragraph 13 to Section IV. Agree to cooperate with any vendors hired by Weld
County Department of Social Services to shorten the duration of placement.
1 Weld County SS-23A Addendum
9. Add Paragraph 14 to Section IV. Agree to schedule physical examinations within 14
days after placement, dental examinations within 60 days after placement and forward all
appropriate information to the County.
10. Add Paragraph 15 to Section IV. A full evaluation of an Individualized Educational Plan
(IEP) for youth designated as a Special Education Student will be conducted every 3
years and reviewed every year. If the IEP is due while the child is in placement, the
Contractor will complete or obtain a completed IEP. A copy will then be forwarded to
the County.
11. Add Paragraph 16 to Section IV. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public(federal, state, or local) transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
C. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local) with commission of any of the offenses
enumerated in paragraph (B) above.
D. Have not within a three-year period preceding this Agreement, had one or more
public transactions (federal, state, and local) terminated for cause or default.
12. Section V, Paragraph 5. Children in Psychiatric Residential Treatment Facilities,
Therapeutic Residential Child Care Facilities, Residential Child Care Facilities and Child
Placement Agencies are not eligible to receive clothing allowances as outlined in the
Weld County Department of Social Services Policy and Procedure Manual.
13. Add Paragraph 7 to Section VI. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of action
relating to such enforcement, shall be strictly reserved to the undersigned parties or their
assignees, and nothing contained in this Agreement shall give or allow any claim or right
of action whatsoever by any other person not included in this Agreement. It is the
express intention of the undersigned parties that any entity other than the undersigned
parties or their assignees receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
14. Add Paragraph 8 to Section VI. No portion of this Agreement shall be deemed to
constitute a waiver of any immunity the parties or their officers or employees may
posses, nor shall any portion of this Agreement be deemed to have created a duty of care
that did not previously exist with respect to any person not a party to this Agreement.
The parties hereto acknowledge and agree that no part of this Agreement is intended to
circumvent or replace such immunities.
15. Add Paragraph 9 to Section VI. The Director of Human Services or designee may
2 Weld County SS-23A Addendum
exercise the following remedial actions should s/he find the Contractor substantially
failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy
the scope of work shall be defined to mean incorrect or improper activities or inaction by
the Contractor. These remedial actions are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
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 Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
16. Add Paragraph 10 to Section VI. The contractor 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 Contractor, within five(5) calendar days
after being served with a summons, complaint, or other pleading which has been filed in
any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Human Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
17. Add Section VII-ATTACHMENTS:
3 Weld County SS-23A Addendum
WELD COUNTY DHS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
IDENTIFYING INFORMATION
CHILD'S NAME STATE ID# EX F I'TRAILS CASE ID DOB
WORKER COMPLETING ASSESSMENT HH# I 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 ❑1)One round trip a week ❑1%z)2 round trips a week
02)3-4 round trips a week. ❑2%z) 5 round trips a week 03)6 round trips a week
03%)7 round trips or more
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
0 Basic Maint.)No participation required 01)Once a month ❑1'%z)Two times month
02)Three times a month ❑2'/z)Once a week ❑3)Two times a week
03%)Three times a week or more
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 ❑1) Less than a''A hour per day ❑1'/z)%z hour a day
❑2) 1 hour a day ❑2 %) 1'/z-2 hours per day 03)21/2-3 hours per day
❑3'%z)More that 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 ❑1)Less than 5 hours per week 01%)5 to 7 hours per week
❑2)8 to 10 hours per week ❑2%z) 11 to 14 hours per week
❑3)Constant basis during awake hours ❑3'%z)Nighttime hours
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?
0 Basic Maint.)0-2 hours per week ❑1)3 to 4 hours per week ❑1%)5 to 7 hours per week
❑2) 8 to 10 hours per week ❑2'/z) 11 to 15 hours per week ❑3) 16 to 20 per week
❑3'%z)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.)
❑1)Face-to-face contact one time per month with child and minimal crisis intervention.
❑1%z)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%z)Face-to-face contact three times per month with child and occasional crisis intervention.
03)Face-to-face contact weekly with child and occasional crisis intervention.
O 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 SS-23A Addendum
WELD COUNTY DHS
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.
Rating of Conditions
(Check one box for each category)
Assessment Areas lions Moderate Severe Comments:
0 1 2 3
Aggression/Cruelty to Animals
❑ ❑ ❑ ❑
Verbal or Physical Threatening
❑ ❑ ❑ ❑
Destructive of Property/Fire
Setting 0 0 ❑ ❑
Stealing
❑ ❑ ❑ ❑
Self-injurious Behavior
❑ ❑ ❑ ❑
Substance Abuse
❑ ❑ ❑ ❑
Presence of Psychiatric
Symptoms/Conditions ❑ ❑ ❑ ❑
Enuresis/Encopresis
❑ ❑ ❑ ❑
Runaway
❑ ❑ ❑ ❑
Sexual Offenses
❑ ❑ ❑ ❑
5 Weld County SS-23A Addendum
BEHAVIOR ASSESSMENT CONTINUED
(Exhibit B)
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)
Assessment Areas None Mild Moderate Severe Comments:
0 1 2 3
Inappropriate Sexual Behavior
❑ ❑ ❑ ❑
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 n 1 ❑ 2 ❑ 3
6 Weld County SS-23A Addendum
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
LEVEL RECOMMENDED RECOMMENDED AGENCY RATE THERAPY RATE MEDICAL
OF SERVICE PROVIDER RATE NEEDS
ADDENDUM
P7-Ps Al TI
Level Rate Case Management Therapy Level
(Admin.Malnt.) (Admin.Services)
Age 0-10...$16.32
($496) Basic Maint $4.93 day/$150mo Level 0 $0
County Age 11-14...$18.05 Therapy not needed or provided
Basic ($549) No crisis intervention,Minimal CPA by Level 0...$0
Maint. Age 15-21...$19.27 (None)
($586) involvement,one face-to-face visit another source,i.e.mental health.
+$.66 Respite Care
($20) with child per month.
$19.73 Level 1 $8.22 day/$250 mo Level 1 $4.93/$150 mo
+$.66 Respite Care Minimal crisis intervention as needed, Regularly scheduled therapy,
1
one face-to-face visit per month with Level 1 ...$2.99
($20.39 day/$620 mo) child, up to 4 hours/month.
2-3 contacts per month
$23.01
1 1/2 4.66 Respite Care Level 1 1/2 $9.86 day/$300 mo
. ($23.67 day/$720 mo)
$26.30 Level 2 $11.51 day/$350 mo Level 2 $9.86/$300 mo
2 +$.66 Respite Care Occasional crisis intervention as needed, Weekly scheduled therapy,
Level 2..$4.47
($26.96 day/$820 mo) two face-to-face visits with child, 5-8 hours a month with 4 hours of
2-3 contacts per month group therapy.
$29.59
2 1/2 4.66 Respite Care Level 2 1/2 $13.15 day/$400 mo
($30.25 day/$920 mo)
$32.88 Level 3 $14.79 day/$450 mo Level 3 $14.79/$450 mo
4.66 Respite Care Ongoing crisis intervention as needed, Regularly scheduled weekly
3 multiple sessions,can include Level 3..$6.02
weekly face-to-face visits with child, more
($33.54day/$1020 mo) and intensive coordination of than 1 person,i.e.family therapy,
multiple services. for 9-12 hours/monthly.
$36.16
3 1/2 4.66 Respite Care Level 3 1/2 $16.44 day/$500 mo
($36.82 day/$1,120 mo)
$39.45 Level 4 $18.08 day/$550 mo Level 4 $14.79/$450 mo
4.66 Respite Care Ongoing crisis intervention as needed, Regularly scheduled weekly
4 multiple sessions,can include
RTC which includes high level of case more Level 4....Ne
9
Drop
Down ($40.77 day/$1220 mo) management and CPA involvement with than 1 person,i.e.family therapy,
child and provider and 2-3 face-to-face for 9-12 hours/monthly.
contacts per week minimum.
Assess $26.96 day/$820 mo
Rate (Includes Respite) $11.51 day/$350 mo
Admin.Overhead Rate: As of 7/01/08
$6.91 day/$210.00 month
7 Weld County SS-23A Addendum
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
Weld County Clerk to the Board
WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By: By:
Deputy Clerk to the Board Chair Signature
CONTRACTOR
«CPA_NAME»
«MAILING_ADDRESS»
«CITY_STATE_ZIP»
By:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Director
8 Weld County SS-23A Addendum
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