HomeMy WebLinkAbout20082586.tiff MEMORANDUM
�_a
( DATE: September 19, 2008
W�`p' TO: William H. Jerke, Chair, Board of County Commissioners
�.FROM: Judy A. Griego, Director, Human Services partment
COLORADO RE: Out-of-Home Placement en aw e d
County Department of Hu Servs and sous
Providers for Consent Agen a
Enclosed for Board approval are Out-of-Home Placement Agreements between the Weld
County Department of Human Services and various providers. These Agreements can be
placed on the Consent Agenda.
Please see attached Memorandum for the major provisions of these Agreements. The term for
all Agreements is July 1, 2008 through June 30, 2009.
If you have questions please give me a call at extension 6510.
Com.ConsentAgenda.OutofHomeAgreements092408 l/`'0�. 79
^ /7/`2008-2586
Cone Kul
RECEIVED AUG 29 2008
(et (} DEPARTMENT OF HUMAN SERVICES
b-\ P.O. BOX A
_ " GRE CO. 80632
Websiteite: wsms.ro.sveld.ro.us
2
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
•
COLORADO
MEMORANDUM
TO: Judy Griego — Director
FROM: Lesley Cobb - Child Welfare Rate Negotiator
DATE: August 28, 2008 'J"il
SUBJECT: Weld Addendum to the Agreements to Purchase Out-of-home Placement
Services (SS-23A)
Attached please find the Weld Addendum to the Agreements to Purchase Out-of-home
Placement Services (SS-23A) for the following providers:
4c'�a.'
d� e ,�.,.._ l cr3SEarloth '
1 Alternative Homes For Youth 2016 $180.75 $180.75 1110 M St Greeley CO 80631
2 Thornton CO
Arapahoe House 88692 $180.75 $180.75 8801 Lipan St 80221
3 10930 Hondo Green Mountain
Childrens Ark, Inc 96480 $164.93 $164.93 Ave Falls CO 80819
4 Green Mountain
Childrens Ark, Inc 4261 $164.93 $164.93 10460 W Hwy 24 Falls CO 80819
5 Childrens Ark, Inc 40322 $164.93 $164.93 400 E Routt Ave Pueblo CO 81004
6 12163 S Perry
Griffith Centers for Children Inc. 49547 $180.75 $180.75 Park Rd Larkspur CO 80118
7 Grand Junction CO
Griffith Centers for Children Inc. 1534554 $180.75 $180.75 1020 Grand Ave 81501
8 Colorado Springs
Griffith Centers for Children Inc. 39212 $180.75 $180.75 17 N Farragut CO 80909
9 Kathleen Painter Littler/North
Range Behavioral 6220 $180.75 $180.75 2350 3rd St Rd Greeley CO 80631
Mountain Crest Poudre Valley
10 Health Care Inc. D/B/A Poudre Fort Collins CO
Valley Hospital 42261 $180.75 $180.75 4601 Corbett DR 80528
5Eginxt H �N'i ti
11 Loveland CO
Namaqua Center/LCMH 1547532 $180.75 $180.75 549 E 8th St 80537
12 Loveland CO
Namaqua Center/LCMH 1547530 $180.75 $180.75 404 E 7th St 80537
13 3500 W 55th
Shiloh Home 32567 $175.59 $175.59 Ave Denver, CO 80221
14 Shiloh Home 20335 $175.59 $175.59 7623 S Estes Ct Littleton, CO 80128
15 7201 S Sheridan
Shiloh House 62291 $175.59 $175.59 Ct Littleton CO 80123
16 7227 S Yarrow
Shiloh House 70967 $175.59 $175.59 Ct Littleton CO 80123
17 6629 W Portland
Shiloh House 54169 $175.59 $175.59 Ave Littleton CO 80123
18 2700 E Ken Pratt Longmont CO
Shiloh House 1539982 $175.59 $175.59 BLVD 80501
19 Youthtrack 11726 $137.90 $137.90 1508 Fillmore Denver CO 80206
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 2008-2009. If you have any questions please call me at Ext. 6441
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Alternative Homes For Youth 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 f t e Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#2016, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing,personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing (3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child(30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
&re— as
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests,plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
Weld County Clerr tCtRe oard
WELD COUNTY BOARD OF
.as r� HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
ti f p it
DEPARTMENT OF HUMAN
oc(v SERVICES
By: By:
Deputy Cl to the Board Chair S gnature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Alternative Homes For Youth
s��'e p, o . 4o/ -I
- heitnten, CO 80260 Daco/1oi Co
y:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
rector +Ler
,J ���...JJJ
4 Weld County SS-23A Addendum
ct- ZR
Exhibit A
ALTERNATIVE HOMES FOR YOUTH, Inc.
SCOPE OF SERVICES
Alternative Homes for Youth's (AHFY) Residential Treatment Facility offers several distinct residential
programs for adolescent males ages 14 to 20. AHFY is an approved Medicaid provider and is licensed by the
State of Colorado as both a Therapeutic Residential Child Care Facility (TRCCF) and a Residential Child Care
Facility (RCCF). Our campus-based education programs, that include Special Education and individualized
education plans, are approved by the Colorado Department of Education.
RESIDENTIAL PROGRAMS
STAFF SECURE TRCCF
AHFY's 26-bed staff secure facility provides offense specific (O.S.) treatment for adolescent males (aged 14-20) who
have been involved with sex offending behaviors and those with other diagnoses/behavioral challenges. The residential
facility is divided into two units, separated by age.
AHFY adheres to the standards and guidelines established by the Colorado Sex Offender Management Board (SOMB),
http://dcj.state.co.us/odvsom/Sex_Offender/index.html, which includes providing supervision and oversight of the O.S.
Treatment Program' by an approved full operating provider. AHFY's clinicians are licensed or provisionally licensed
therapists, responsible for providing treatment services and coordination of their clients' individual treatment plans, which
are developed in collaboration with the Multi-Disciplinary Team (MDT). The Clinical Team is supervised by AHFY's
Clinical Director, who is a licensed professional counselor and approved Medicaid provider. Education staff include a
master's level administrator/special education teacher, a special education generalist teacher and 2 certified para-educators
Criteria for admission:
Most of the adolescents referred to AHFY have multiple diagnoses and challenges. We recognize that not all programs
can meet the needs of nor be successful with every youth; therefore we are very selective about who we accept, based on
who we believe we are best able to help.
Minimum criteria for admission into residential program are as follows:
• Male youth, admitting to sexual offense(s), fourteen to twenty years of age
• Youth able to keep self and others safe without constant redirection
• Youth with current sexual offense adjudications,or
• Youth who are in the process of being adjudicated for a sexual crime, or
• Youth who have been adjudicated of other crimes, and have inappropriate sexual behaviors that were not included
in their adjudication, but must be addressed and are a treatment priority, and/or
• Youth with sexual or incestuous crimes against other children and
• Youth who have admitted to an offense and are invested in changing their sexually abusive behavior
• Youth with adequate intelligence and social functioning(IQ>70)
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice. Updated 01/10/08(DSS)
•
The average length of stay for those youth completing the treatment program is < 7 months; AHFY's current
success rate is 85% for successful discharges.
The Treatment Package includes:
• Survivors of Sexual Abuse Group- this group is exclusively for those clients who are victims of sexual abuse.
This is a supportive, therapeutic group facilitated by two master level clinicians and supervised by the SOMB
Provider. `Survivors Group' meets one time every other week at 1 % hours per session.
• Healthy Relationships Group- This group is psycho-educational in nature and teaches the clients about healthy
relationships, including healthy sexuality, domestic violence, power and control, communication, and values
exploration.This group meets weekly and is facilitated by a team of counselors.
• Substance Abuse Group Therapy- This intervention and education group is only open to those clients that have
abused drugs and/or alcohol. The curriculum is dynamic, although themes that will be addressed are as follows:
relapse prevention, role plays, guided imagery, education on how substances affect the body, and sobriety
celebrations as is modeled after a curriculum that was accepted by the Alcohol and Drug Abuse Division. This
group meets weekly and is supervised by a Licensed Professional Counselor, Certified Addictions Counselor-
Level III.
• Parents Group- This group provides an opportunity for the clients' parents to learn about the concepts their sons
are learning in treatment, as well as to offer support to each other. All parents are encouraged to attend and
regular participation in this group is a requirement for the parents to be able to take their sons on pass, when
appropriate. Parents group is held monthly for at least 1 1/2 hours per session and is conducted by a Master level
therapist.
• Education- AHFY provides an on-site education program for both middle and high school level students that
includes Special Education services, Individual learning contracts and GED preparatory classes. AHFY's
education programs are approved by the Colorado Department of Education.
• Independent Living Skills- All youth receive education and training in independent living skill development. The
older youth meet weekly in a group setting to learn various independent living skills including: how to prepare
meals, shop on a budget, file taxes, look for a job, prepare a resume, complete a job application, obtain
identification, find insurance, apply to college, apply for financial aid, clean a house, do laundry, maintain good
hygiene, use public transportation, open a checking/savings account, write a check, pay a bill, etc. The
curriculum incorporates the Casey Life Skills curriculum.
• Ongoing risk assessment- Clients' levels of risk to the community will periodically be re-assessed using the
Juvenile Sex Offender Assessment Protocol-II(J-SOAP II, Prentky and Righthand).
• Informed Supervision: 2 levels of informed supervision are provided for parents and other approved adults.
• Room and Board- each youth shares a room with no more than three other youth and receives three nutritional
meals and two snacks daily. A weekly allowance,based on accomplishments, is also provided.
• Case Management-Each client receives a minimum of 10 hours/month of case management provided by the Case
Manager in collaboration with the client's therapist to ensure consistency of care.
• Milieu Therapy-The milieu is staffed at a minimum of 1 Youth Advisor for every 10 clients. In addition, a back-
up Youth Advisor or a supervisor is available for support during the youths' waking hours. Overnight, during
sleeping hours, the milieu is staffed with 1 (awake) Youth Advisor for every 11 clients. Bed checks are
conducted randomly at least four times per hour. A licensed clinician is always on-call.
The current daily rate for this program is$178.08.This rate is subject to change pending the anchor rate to be
established by the State for fiscal year 2008-2009.
Offense Specific(OS)treatment services are not included in the State's"anchor"rate nor are they covered under
Medicaid. Therefore,the following"guideline"was established by the State for counties to negotiate with providers for
offense specific treatment services not covered by Medicaid:
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
•
1 individual session/week
2 groups/week
1 family/multi-family per week
Per child per diem rate-$19.84 for this entire package
Single sessions
One individual a week only- $7.77 a day
2 groups a week only-$4.41 a day
1 family/multi family a week only-$7.66 a day
The O.S. treatment services are included for Weld County DSS clients.
The following services are provided for Medicaid recipients*; billed to and paid by Medicaid:
■ Cognitive Behavior Group Therapy- This group consists of a psycho-educational component and a
therapeutic component. This group focuses on teaching the clients how to recognize how their
cognitions affect their behavior and gives opportunity for the clients to practice healthy ways of thinking
and behaving in an effort to create healthier lifestyles. This group focuses directly on decreasing
symptoms of various Axis I mental health diagnoses for each client. This group meets twice weekly for 1
1/2 hours per session and is facilitated by a Licensed Professional Counselor with Full Operating Level
Provider status and is co facilitated by a licensed or provisionally licensed therapist.
• Individual Therapy - We recognize that not every client will benefit from talk therapy alone. Therefore,
our therapeutic team utilizes an eclectic, client-centered approach to addressing Axis I diagnoses.
Included in the therapeutic modalities are:Art Therapy, Internal Family Systems Therapy (IFS), Gestalt
Therapy, Body Awareness Therapy, Cognitive Behavioral Therapy and Eye Movement Desensitization
and Reprocessing (EMDR). Each client is assigned a therapist. The client will meet with his therapist
for a minimum of one hour per week. This therapist will also collaborate with the Case Manager to
ensure consistency of care.
• Family Therapy- AHFY believes that family involvement is crucial to the success of our clients.
Therefore, whenever possible, family therapy is scheduled weekly. Regular attendance and
participation in family therapy is a requirement for parents to be able to take their sons off grounds.
* These services are also available for non-Medicaid eligible clients on a fee-for-service basis. See fee for service
menu.
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
•
INDEPENDENT LIVING PROGRAM
For youth who are eligible and determined to be appropriate; AHFY's Independent Living (IL) program provides a less
restrictive opportunity while in residence for youth who are preparing to transition back into the community as
independent young adults.
Reasons for referral can include:
• youth who have committed a sex offense, in which case the residential program admission criteria would apply or
• youth who have not committed a sex offense but have other diagnoses/behavioral challenges. In this case, criteria
for acceptance into the program are determined on a case by case basis.
Minimum criteria for admission into Independent Living program are as follows:
• Male youth, age 16 and older
• Must have completed the majority of the core components of their treatment plan(either at AHFY or elsewhere)
• Must rate as a"low safety risk"to the community
• Could benefit from additional support involving a gradual transition or those who do not have the option of
returning home or to live with family.
• Must have successfully passed a sex history polygraph(as appropriate)
• The MDT has determined that this client is mature enough to be safe and responsible within the community
The Independent Living program is specifically designed to teach and develop independent living skills. This program
prepares youth to transition from AHFY into a community living arrangement, seek and obtain employment and attend
public school, higher education classes or a trade school. The youth in this program will be encouraged to be spending
most of their time in the community, either at their place of employment or public school, trade school or college. The
agency's staff are available at all times if the client needs support throughout the day.
A sample of the Independent Living Skills addressed in this program:
• Utilizing public transportation
• How to complete a resume
• How to complete a job application
• How to interview for a prospective job
• Managing a bank account
• Budgeting and shopping
• How to disclose to an employer
• Finding housing
• Run a household(hygiene,bills, supplies, etc)
• How to file taxes
• How to apply to college/school
• How to secure financial aid and its meaning
The Independent Living Program package:
The program package includes all of the same services as are provided in AHFY's staff secure Therapeutic Residential
Treatment program. However, due to the various daily schedules of each client, they may not be involved in every aspect
of the program offered in the residential service package. However, the following two groups are required for
participation in the Independent Living Program:
• After Care Group-This group will process various life issues as it relates to their already received offense specific
therapy. Each client will begin the group by presenting his relapse prevention plan and the group offers a
supportive, process oriented environment in which to process how they are applying their treatment to their new
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
independence. This group is facilitated by a Master's Level Therapist and supervised by a Full-Operating Level
Provider recognized by the SOMB and occurs weekly.
• Independent Living(IL) Skills- In addition to working with their individual mentors,the IL youth meet weekly in
a group setting to learn various independent living skills including: how to prepare meals, shop on a budget, file
taxes, look for a job, prepare a resume, complete a job application, obtain identification, find insurance, apply to
college, clean a house, do laundry, maintain good hygiene, use public transportation, open a checking/savings
account,write a check,pay a bill, etc. The curriculum incorporates the Casey Life Skills curriculum.
In addition,the following service is included to provide increased support for IL participants:
• Employment Support and Skill Development-All youth in the Independent Living Program are assigned a mentor
to support them in their learning processes and growth. A key part to the Independent Living Program is the
support the youth are provided with regard to learning about, seeking out, and sustaining adequate and appropriate
employment. AHFY's Case Manager provides direct guidance to our youth for this programmatic component.
Everything from supporting the youth in picking up job applications to interviewing and securing a job to
dropping by to check on their employment progress while keeping an open communication relationship with their
supervisor are all included in the Independent Living program's employment support component.
The current daily rate for this program is $178.08. This rate is subject to change pending the anchor rate to be
established by the State for fiscal year 2008-2009.
Offense Specific(OS)treatment services are not included in the State's"anchor"rate nor are they covered under
Medicaid. Therefore, the following"guideline"was established by the State for counties to negotiate with providers for
offense specific treatment services not covered by Medicaid:
1 individual session/week
2 groups/week
1 family/multi-family per week
Per child per diem rate-$19.84 for this entire package
Single sessions
One individual a week only-$7.77 a day
2 groups a week only-$4.41 a day
1 family/multi family a week only-$7.66 a day
The O.S. treatment services are included for Weld County DSS clients.
The following services are provided for Medicaid recipients*; billed to and paid by Medicaid:
• Cognitive Behavior Group Therapy- This group consists of a psycho-educational component and a
therapeutic component. This group focuses on teaching the clients how to recognize how their
cognitions affect their behavior and gives opportunity for the clients to practice healthy ways of thinking
and behaving in an effort to create healthier lifestyles. This group focuses directly on decreasing
symptoms of various Axis I mental health diagnoses for each client. This group meets twice weekly for 1
h hours per session and is facilitated by a Licensed Professional Counselor with Full Operating Level
Provider status and is co facilitated by a licensed or provisionally licensed therapist.
• Individual Therapy - We recognize that not every client will benefit from talk therapy alone. Therefore,
our therapeutic team utilizes an eclectic, client-centered approach to addressing Axis I diagnoses.
Included in the therapeutic modalities are: Art Therapy, Internal Family Systems Therapy (IFS), Gestalt
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
Therapy, Body Awareness Therapy, Cognitive Behavioral Therapy and Eye Movement Desensitization
and Reprocessing (EMDR). Each client is assigned a therapist. The client will meet with his therapist
for a minimum of one hour per week. This therapist will also collaborate with the Case Manager to
ensure consistency of care.
• Family Therapy- AHFY believes that family involvement is crucial to the success of our clients.
Therefore, whenever possible, family therapy is scheduled weekly. Regular attendance and
participation in family therapy is a requirement for parents to be able to take their sons off grounds.
* These services are also available for non-Medicaid eligible clients on a fee-for-service basis. See fee for service
menu.
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
In keeping with our belief that it is critical to treat the whole of the child through on-going care and
support, AHFY offers the following continuum of care services in addition to the above programs,
offered on both an inpatient and outpatient level of care.
FEE-FOR-SERVICE MENU:
(Services may be provided by AHFY or through a third party provider)
Outpatient Therapy Services
• Individual Therapy- We recognize that not every client will benefit from talk therapy alone. Therefore, our
therapeutic team utilizes an eclectic, client-centered approach to addressing Axis I diagnoses. Included in the
therapeutic modalities are: Art Therapy, Internal Family Systems Therapy (IFS), Gestalt Therapy, Body
Awareness Therapy, EMDR and Cognitive Behavioral Therapy. Each client is assigned a therapist. The client
will meet with his therapist for a minimum of one hour per week. This therapist will also collaborate with the
Case Manager to ensure consistency of care.RATE: on-site sessions* @$60 per 50 minute session.
• Family Therapy- AHFY believes that family involvement is crucial to the success of our clients. Therefore,
whenever possible, family therapy is scheduled weekly. Regular attendance and participation in family therapy is
a requirement for parents to be able to take their sons off grounds. RATE: on-site sessions* @ $60 per 50 minute
session.
• Group Therapy-AHFY provides a plethora of groups, from Cognitive Behavioral Therapy Group to Parent
Education Group to Substance Abuse Therapy Group. AHFY draws from a variety of modalities and focuses the
group format based on"best practices" approaches, coupled with the needs of the group members. RATE: on-site
sessions* @ $35 per 50 minute session.
* travel to client's home or other location will be billed at $45/hour (pro-rated by quarter hour) and includes
therapist's time& mileage.
Drug Screening—Saliva or Urine Analysis: AHFY offers either a 6 panel instant oral(saliva) test or a 5 panel urine dip
(UA). Both screens test for Methamphetamines (meth), cocaine, opiates, THC, and amphetamines with the addition of
PCP with the saliva screen. Substitutes can be made for meth and THC with the urine dip but no substitutes can be made
with the saliva screen. All residents returning from pass receive a UA. This service is also available on an out patient basis
for clients who receive no other services at AHFY.
RATE: $12.00 per test
Mentoring: Depending on the level of mentoring recommended, a variety of mentoring services are available from
multiple weekly to once monthly support contacts. Job coaching, help with homework, co-involvement in pro-social
activities are a few examples of what the AHFY mentoring program offers the youth.RATE: $26.00 per hour.
Parole Tracking, Electronic Home Monitoring (EHM) and Global Positioning System (GPS) Monitoring: This
program component works with DYC Client Managers, youth and their families to develop an appropriate level of
tracking services for each youth. These services may include verification of client whereabouts, electronic monitoring
(telephone and/or "ankle bracelet"), Global Positioning System (GPS) Monitoring, urinalysis testing, and face to face
contacts. AHFY "trackers" make regular contact with clients' families, school personnel, employers, DYC Client
Managers, and other primary persons to ensure safe and successful reintegration of youth with the community-at-large.
AHFY trackers provide services to clients twenty-four hours per day, seven days per week. Rates are established based on
individual client needs.
Polygraph Examinations: are scheduled and coordinated by AHFY with a third party licensed polygraph examiner.
Refer to Section 7.1 of the SOMB standards for requirements and details of the polygraph examination process. Rates for
this service are set by the polygrapher and can range from$200 - $250 per examination.
Alternative Homes for Youth's Scope of Services--For more information on any of AHFY's service components,please contact our Clinical Director at 303-881-1247.
The information contained herein is subject to change without notice.
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Arapahoe House 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 f t Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#88692, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child(30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum' p (?/
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
illATTEST: M___
Weld County Cler e:B49-"
/ ` WELD COUNTY BOARD OF
sa' gym, HUMAN SERVICES, ON BEHALF
CI ' OF THE WELD COUNTY
't. - .• . y. DEPARTMENT OF HUMAN
w`/.4 ..s! ' • SERVICES
By: By: fr: f'`Y
Deputy erk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Arapahoe House
8801 Lipan St
Thornton, CO 80260
B ' /,
By:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
irector
4 Weld County SS-23A Addendum
o?c9c?--a5a
. , r ,
Exhibit A
1) Scope of Service- The Arapahoe House, Inc. StepWise program is licensed as a
Therapeutic Residential Child Care Facility(TRCCF) and Residential Child Care Facility
(RCCF), as well as licensed by the Alcohol and Drug Abuse Division.
The program is designed to afford a sheltered,but structured, treatment environment to
adolescents with mental health and substance abuse problems. Treatment is tailored to
the individual needs of each young person. The program can serve 20 youth, both male
and female ages 12-17.
An accredited on-site school is provided for clients who have not received a high school
diploma or are working towards their GED. Job skills training services are available to
age appropriate clients.
Treatment services include a variety of psychoeducational and process oriented therapy
activities including groups, individual and family sessions. Topics include but are not
limited to recovery from substance abuse, mental health and trauma related problems,
relationships, anger management, tobacco cessation,health and wellness, self esteem, etc.
Resource linkage and service coordination is also offered as part of the program.
The current average length of stay for the StepWise program is approximately 75 days
during which time the primary goals are to stabilize substance abuse and mental health
related issues, help youth develop skills to effectively manage their behaviors and
emotions in the community, increase family connectedness as possible and ensure that
proper services are in place for the youth's transition to a lower level of care.
The treatment team consists licensed and/or CAC certified professionals as well
educational and medical staff.
2) Daily Rate for service - The '07-'08 approved rate for the StepWise program is $178.08.
The '08-'09 rate has not yet been established.
3) Menu of services -No additional treatment fees are being requested.
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Childrens Ark, Inc and Weld County Department of
Human Services for the period from
July 1, 2008 through June 30, 2009.
The following provisions, made this /5N, day of J a ( , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of tife Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#4261, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum
&08- as<
i
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 to Section I. A minimum of one polygraph test per Colorado fiscal
year, if needed by the child, will be famished under this contract for facilities that
provide sex offender treatment.
5. Add Paragraph 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests,plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
I
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Mill
Weld County Vet
^�' ,
rWELD COUNTY BOARD OF
4 HUMAN SERVICES, ON BEHALF
" i . OF THE WELD COUNTY
+ h .. DEPARTMENT OF HUMAN
--...1:::1-4--- SERVICES
BY: 412914 t{yj, 1C/Y Fi .1 By: 4/1
(2,7_---7
Deputy Cl rk to the Board Chair ignature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Childrens Ark, Inc
10460 W Hwy 24
Green Mountain
�Falls, CO 80819
By: p "�.,d—�
in
cycinccm
WELD COUNTY DEPARTMENT 5,0/t ( ,ge.�w1o1rl
OF HUMAN SERVICES J
By:
irector
4 Weld County SS-23A Addendum
,200c- asc
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Childrens Ark, Inc and Weld County Department of
Human Services for the period from
July 1, 2008 through June 30, 2009.
The following provisions, made this/5-14 day of 1 , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of dfe Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#40322, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addenddum? d 5960
•
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
iaaaidit
ATTEST:
Weld County Cle ',6ay'd
Q ", R
r'
a � WELD COUNTY BOARD OF
m J HUMAN SERVICES, ON BEHALF
F' OF THE WELD COUNTY
DEPARTMENT OF HUMAN
-- !d L ! % SERVICES
By: By: A
Deputy Cpl rk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Childrens Ark, Inc
10460 W Hwy 24
Green Mountain Falls, CO 80819
By: ,Scoff a o� V)c
att
WELD COUNTY DEPARTMENT C¢ 1C7
OF HUMAN SERVICES
By: a
)hector
4 Weld County SS-23A Addendum
,2008--a 5�
t
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Childrens Ark, Inc and Weld County Department of
Human Services for the period from
July 1, 2008 through June 30, 2009.
The following provisions, made this /51/-; day of J u ( , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of t1 Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#96480, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$164.93 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include,but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
°led'- Q58
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation,recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Mk)
Weld County Clerk t i),_.
a, � i a\t\ WELD COUNTY BOARD OF
#� i HUMAN SERVICES, ON BEHALF
�`c, ,, f-- OF THE WELD COUNTY
�t `,. // DEPARTMENT OF HUMAN
c ,1, i \°'\,'_r'i` SERVICES
BY: i/lit1/4„n . mil' By: W-A
Deputy C k to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Childrens Ark, Inc
10460 W Hwy 24
Green Mountain Falls, CO 80819
BC
7e/7/i 439, 7A✓, Kite%
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
irector
4 Weld County SS-23A Addendum
cons a58
r
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Griffith Centers for Children Inc. 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 t Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#49547, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include,but are not limited to:
Food, shelter, clothing,personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
&W— a 5
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests,plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
9. Add Paragraph 14 to Section W. 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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Midalit
Weld County Clerk rd if a WELD COUNTY BOARD OF
" HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
i e < f e ,s0 DEPARTMENT OF HUMAN
/ SERVICES
By: �/� By:
Deputy C rk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Griffith Centers for Children Inc.
14142 Denver West Pkwy,
Suite#225
Lakewood, CO 80401-3189
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: a
rector 1
(
4 Weld County SS-23A Addendum
&e a-asd
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Griffith Centers for Children Inc. 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 Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#1534554, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include,but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum
a2Od8- &5a
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests,plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 W. Agree to cooperate with any vendors hired by Weld
County Department of Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
•
Is
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: l --"7 ____ '__
Weld County crt
rn/ `ctx WELD COUNTY BOARD OF
igtl ��` If. HUMAN SERVICES, ON BEHALF
M1, , s. J OF THE WELD COUNTY
�. ; t` A DEPARTMENT OF HUMAN
r� SERVICES
4
By: /� i� By: � �
Deputy C.I€rk to the Board
� Ch it Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Griffith Centers for Children Inc.
14142 Denver West Pkwy,
Suite#225
Lakewood, CO 80401-3189
B . - 7 -2 =v£-
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: ?,(A11.6..
'rector
J
4 Weld County SS-23A Addendum
020,0?- a511
•
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Griffith Centers for Children Inc. 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 Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#39212, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: �°1_'_y ___
Weld County C 1 ty�s�so
' Y WELD COUNTY BOARD OF
I HUMAN SERVICES, ON BEHALF
a r
� .' 'y OF THE WELD COUNTY
/
DEPARTMENT OF HUMAN
SERVICES
By 4 d, By:
Deputy CI to t e 1%C��I.�G �/Board hair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Griffith Centers for Children Inc.
14142 Denver West Pkwy,
Suite#225
Lakewood, CO 80401-3189
aatz-4-91' --------
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
a--
Di ector
4 Weld County SS-23A Addendum
aOO8-as
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Kathleen Painter Littler/North Range Behavioral 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 t Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#6220, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff,parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household famishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
002068-0,25
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation,recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
Weld County rltitia0ard,,
. WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
c'r i f. :' OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By: At t; By:
Deputy Cl £to e Board Ch it Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Kathleen Painter Littler/
North Range Behavioral
2350 3rd St Rd
Greeley,
, CO 806311/
BY: W +t A/*n lif�Q WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Di i ctor
4 Weld County SS-23A Addendum
aoad'- a
Exhibit A
Kathleen Painter Littler Center
Scope of Services:
The Kathleen Painter Littler Center, a facility run by North Range
Behavioral Health, provides residential and day treatment for children aged 5-
14 needing placement due to severe emotional and behavioral problems. We
work to stabilize children to facilitate their return to a less-restrictive setting.
The residential program has a capacity of 24 children; the day treatment can
accommodate 12 children.
Mental Health Professionals supervise and monitor the children 24 hours
per day. Each child receives intensive therapeutic services, including
Individual, Group, and Family Therapy, milieu Peer Groups, Psychiatric
Assessment and Evaluation, Medication Management and Case Management.
Therapy and Case Management is provided by Master's-level, Licensed
Professional Counselors and Social Workers.
Children admitted to the Littler Center attend school in a therapeutic
educational program offered in collaboration with Weld County School
District 6. Educational services include small self-contained classrooms,
individualized curriculum, Colorado-licensed instructors, educational testing
and evaluation, speech and occupational therapies, computerized learning
programs, and recreation.
II. Facility History
In the 1990's, North Range Behavioral Health, a private, non-profit
corporation governed by a volunteer Board of Directors, recognized a need for
a community-based alternative for emotionally- and behaviorally-troubled
children who had experienced abuse, emotional trauma, or other
developmental disruptions. NRBH endeavored to aid children aged 5-12 who
could not be managed at home or school, and who would otherwise be sent to
the State Hospital or to other facilities outside the local region. The Board
understood that providing services closer to the child's home makes it
possible for greater family participation in the child's treatment, and a greater
likelihood of returning the child home and to his/her local school more
quickly.
To address this need, two programs began in 1995:
i. The Children's Acute Treatment Unit (CATU), an eight-bed
residential facility operated by NRBH, and
ii. The Carson Project, a day treatment program operated jointly by
Weld County School District Six and NRBH.
Four years after launching these programs, in 1999, a newly-constructed
15,000 square foot facility occupying a six-acre site made it possible to merge
the two entities into a coordinated service program, named the Kathleen
Painter Littler Center. In addition to benefiting northeastern Colorado children
and families, the Littler Center also routinely treats children from other
counties, as well, as space allows.
Exhibit A 2
In 2008, the age-range was expanded; the Littler Center now accepts
children ages 5-14.
III. Staffing Band
The ratio of Mental Health Professionals to number of children in our care
depends on the needs of the children,but shall not be less than the following:
a. 1 Mental Health Worker per 5-6 children during waking hours; 1 Mental
Health Worker per 12 children during sleeping hours
b. Teachers, Mental Health Workers, and other school staff as contracted by
Weld County School District Six
c. 1 Master's-level Therapist or Social Worker per 6-8 children
d. Additional staff: Psychiatrist, Nursing Staff, Program Director, Clinical
Director, Maintenance Staff, Kitchen Staff, Administrative Assistants,
Interns, Volunteers
IV. Staff Roster
a. Dave Rastatter—NRBH Director of Child and Family Services
b. Joanna Martinson—Litter Center Program Director
c. Pamela Collins Vaughn—Littler Center Clinical Director
d. Dr. Scott Shannon - Psychiatrist
e. Lisa McConnell—Behavioral Health Registered Nurse
f. Cindy Schmidt—Health Office
g. Jackie Sanders—Intake Coordinator/Therapist/Case Manager
h. Sarah Polzin—Therapist/Case Manager
i. Nikki Juergensen—Therapist/Case Manager
j. Amy Williams—Therapist/Case Manager
k. Tammy Humphrey—Residential Unit Supervisor
1. Meghann Schaffer—Residential Unit Supervisor
m. Dorene Thorgesen—Administrative Assistant
n. Mental Health Workers—provide care on the residential unit
o. Primaries - assigned to work with the children on an individual basis
p. Betty Benavidez—Kitchen Manager
q. Steve Lockhart—District Six Colorado-Licensed Teacher
r. Devon Widner, Kimberly Willis, Sandra Mayer, Caleb Holman— Contract
Teacher Associates
s. Aaron Watkins—Music Therapy provider
t. Bill McConnell—Maintenance, Safety
u. Beverly Thomgate—Human Resources
V. Philosophy of Care:
At the Littler Center, we believe in treatment, not containment. Our
Quality Improvement team has adopted the vision that, "We must move from viewing
the individual as failing if s/he does not do well in a program to viewing the program
as not providing what the individual needs in order to succeed" (Dubovsky). The
overall guiding principle is to facilitate positive interventions in the management of
Exhibit A 3
our children's behaviors. Behavior management and treatment interventions support
the acquisition and reinforcement of adaptive/replacement behaviors through a
variety of interventions. The Kathleen Littler Center Behavior management Policy
states that Personal Restraints and use of Locked Quiet Room is always used as a last
resort. All behavior management will be positive/supportive and never punitive.
Environments that are positive, preventive, predictable, relevant, nurturing and
effective are safer, healthier and more caring.
We also believe that children do well if they can. In the circumstances where
children cannot do well, adults bear the responsibility of figuring out why and what
they need to help them succeed. This "success" is accomplished through adults
developing healthy relationships with the child, providing nurturance and a
supportive environment, and teaching the child the appropriate coping skills. Our
care model uses a unique blend of Collaborative Problem Solving (as explained in Dr.
Ross Greene's books The Explosive Child and Treating the Explosive Child) and
Positive Behavior Support strategies. Once a child is ready for discharge the staff at
Kathleen Painter Littler Center make every effort to help the child transition
successfully to a new environment.
VI. Services Offered by the Littler Center include, but are not limited to:
a. Individual Therapy
b. Family Therapy(When appropriate, In-Home therapy is encouraged.)
c. Group Therapy(including, but not limited to: )
i. Anger Management and Conflict Resolution
ii. Art Therapy—(pending)
iii. Communication Skills
iv. Coping Skills
v. Music Therapy
vi. Recreation Therapy, including Yoga and Pilates
vii. Self-Esteem
viii. Sexual Reactivity
ix. Social Skills
d. Other
i. Boy Scouts/Girl Scouts
ii. Healing Garden(Children learn to grow vegetables and herbs.)
iii. Recreation Groups and Outings
iv. Scrapbooking
v. Tai Chi
vi. Voluntary Bible Class
vii. Primary time: Intensive time for the child to spend 1:1 with a staff
person, learning life skills and engaging in special activities the
child enjoys (such as acting class, recreational sports, shopping or
just time away from the residential unit).
e. Weld County School District Six provides the children with Occupational
Therapy and Speech Therapy.
VII. Goals for Transition/Step-Down Services
•
Exhibit A 4
Children are transitioned to a less-restrictive environment as soon as goals
established by the Multi-Disciplinary Team have been met. Children may
"step-down" from Residential Treatment to Day Treatment. (Day Treatment
involves the child continuing to attend school on the Littler grounds but
returning home after the school-day ends.)
VIII. Average Length of Stay
In 2007, the average LOS for Residential children was 6.7 months; Day
Treatment children averaged a LOS of 6.9 months.
IX. Financial Impact for Level C Clients
North Range Behavioral Health currently charges $180.67 per day,
including room, board and maintenance. Should a child need 1:1 care, the
county seeking placement and the Program Director negotiate charges based
upon the child's needs.
X. Medical Coverage
a. The Medical Team consists of a Psychiatrist, Behavioral Health
Registered Nurse, and Nurse Aid. In addition to scheduled hours on-site,
Medical Staff is available for emergency services or consultation 24 hours
per day.
b. Littler Staff schedule children for and provide them transportation to and
from off-site medical, vision, and dental appointments, as needed and
required by Colorado Medicaid regulations.
XI. Average Daily Schedule for Residential Children during the School
Year:
Children are divided into small groups called Huddles. The Huddle
leaders plan activities that are creative, interactive, and provide a variety of
learning experiences. In addition, Huddle groups complete numerous chores
and participate in community service projects. The goal of these Huddles is to
teach and assist the child with learning problem-solving skills, work on
getting along with others, and to practice the skills they are learning in
therapy.
7:00 am-8:00 am: Waking up, showering, cleaning rooms
8:00 am-8:30 am: Breakfast
9:00 am-9:30 am School work
9:30 am-10:30 am: Monday, Wednesday, Friday: Group Therapy
Tuesday, Thursday: Physical Education
10:30 am-11:30 am: School
11:30 am-12:30 am: Lunch(rotating basis,by class)
12:30 pm-3:00 pm: School
3:00 pm-3:30 pm: Outside activities
3:30 pm-4:15 pm: Homework
Exhibit A 5
4:15 pm-5:00 pm: Group
5:00 pm-5:30 pm: Outside activities
5:30 pm-6:00 pm: Dinner
6:00 pm-7:00 pm: Quiet activities
7:00 pm-8:00 pm: Educational television
8:00 pm-8:30 pm: "Mellow Minutes" (reading books, quiet
individual games,music)
8:30 pm: Bedtime
XII. Therapy Sessions
Therapeutic services vary by contract, but most children receive not less
than one Individual Therapy session per week, not less than one Family Therapy
session per week, and not less than three Group Therapy sessions.
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Mountain Crest Poudre Valley Health Care Inc.
DB/A Poudre Valley Hospital 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 o the reement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#42261, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing,personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing (3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
1 Weld County SS-23A Addendum
&O A— Q58
soap, combs, haircuts, and other essentials (2%);
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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,
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
4
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ifid
ATTEST: L
Weld County Cl tQttid ¢ar" .
`r'
• ' WELD COUNTY BOARD OF
s >?
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
\‘',"11 DEPARTMENT OF HUMAN
1 SERVICES
By: /�/,)ya>t, By:
Deputy erk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Mountain Crest Poudre Valley
Health Care Inc.
D/B/A Poudre Valley Hospital
4601 Corbett DR
Fort Collins, CO, 80528
By: I z
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Di ector
4 Weld County SS-23A Addendum
WELD COUNTY ADDENDUM
-,„,,
To that certain Agreement to Purchase Therapeutic Residential Child Care "
/
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Namaqua Center/LCMH 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 DQ„�A , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#1547530, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
] Weld County SS-23A Addendum
o7ao A- 0075(PG
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Ltie �le_"
Weld County Cler
f. F WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
f,. J^ � OF THE WELD COUNTY
��•. ! _ ,�' .�, .-- DEPARTMENT OF HUMAN
, . SERVICES
By: By: v
Deputy C rk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Namaqua Center/LCMH
404 East 7th Street
Lovel , CO, 8 7
By: "V
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES n
By: 4 *A-LAVE)
-)Dir ctor
kJ
4 Weld County SS-23A Addendum
O7OOP—c.
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Namaqua Center/LCMH 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 th greement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#1547532, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$180.75 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing,personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
(.9c68-&58&,
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
lama
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: iate#4" "
Weld County Clerk t
•
,r A WELD COUNTY BOARD OF
'cc' t `.n --` HUMAN SERVICES, ON BEHALF
A 1,+ :; �� OF THE WELD COUNTY
t r 2' _1 DEPARTMENT OF HUMAN
,.
SERVICES
By: By: v ,
Deputy Cl to the Board Chair Signature
William F. Garcia, Chair Pro-tem
09/24/2008
CONTRACTOR
Namaqua Center/LCMH
404 East 7th Street
Lovel d, CO 8 7
By:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: Ck-
Di ector
4 Weld County SS-23A Addendum p
AGO0 —
• ' Exhibit A
Namaqua Center's
8th Street Residential Program
1. Scope of Service
For the past 31 years, Namaqua Center has worked almost exclusively with abused and
neglected children and families that are involved with the Child Welfare system.
Our 24-hour treatment home specializes in healing children and families struggling with
multifaceted issues pertaining to attachment, trauma, and sexual reactivity. Our Er Street
location is a co-ed home that focuses on children ages three through twelve. We work in
creative, flexible, and strength based ways with involved families and support systems. We
utilize the latest in brain-based interventions based on the work of Allan Schore, Bruce
Perry, and Bryan Post.
Namaqua Center's residential program does not accept children who are in the pre-
adolescent or adolescent stages of development or primarily demonstrate proactive
aggression. Additionally, we do not typically work with children with criminal charges, on
probation, or have extensive medical issues.
Namaqua Center's treatment staff is comprised of a consulting psychiatrist, consulting
psychologist, licensed residential director, two master's level therapists, a bachelor's level
medical liaison/case manager, and bachelor's level counselors. Our staffing ratios are 3:1
during the school day, 3.5:1 evenings and weekends, and 7:1 for overnight.
We operate an on-site facility school. We also have a strong working relationship with the
Thompson School District for children that need a public school setting.
The program has a strong emphasis on comprehensive service plans for the whole family
that either maintains children within their home or places them permanently with another
family. To reduce length of stays, we have provided home based family therapy, increased
the number of family sessions, provided intensive case management for the family, helped
to secure needed resources for the family, and provided trauma based educational seminars
for families. (Some of these services have required an additional fee i.e., Larimer County
pays for travel time to a family's home.)
We offer a cognitive behavioral program for sexually reactive youth that includes a
structured milieu approach, Twelve Steps to Healthy Touching curriculum. The Twelve
Steps to Healthy Touching is a therapeutic treatment tool for young children who have
sexually acted out with other children. The goal is to help sexually reactive youth
understand and accept responsibility for their problems, teaching them to express their
feelings, and fostering the belief that their behavior can be controlled if they learn to monitor
warning signs and ask for help when they need it.
As an aftercare program, we also offer Behavior Coaching. A 6 to 8 week in-home service,
provided for families when their child returns home. The coaching team consists of the
therapist and a direct care worker who has the advantage of an established relationship with
the family and child. The behavior coach and/or therapist spend two to four hours in the
home weekly. They guide the family in developing a consistent structure, use of behavior
strategies, and family regulation. This can be an essential service to increase the family's
ability to maintain their child in their home. This is an additional fee typically paid through a
core Service single case agreement.
2. Daily Rate of Service
Our daily rate for service for the 2008 -2009 FY will be the state anchor rate.
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh Home 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 t Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#20335, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
aa08- as8G1
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests,plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: _
Weld County Cl d' Dar
1i
\ WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
1 ' OF THE WELD COUNTY
'O . " 1. DEPARTMENT OF HUMAN
SERVICES
BY: 4211.,C_ a th By: Vu%(
Deputy C rk to t e Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh Home
6400 W Coal Mine Ave
Littleto . CO 8
By: v
St yen E. Ramirez EO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: CU
'rector
4 Weld County SS-23A Addendum
o?oc,c- d5(
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Littleton
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF) to male youth ages eight to eighteen years old. The Littleton site is comprised
of five facilities: Yarrow and Estes offense specific milieus, age ranges 12— 18 years, 8
clients per house capacity; Sheridan, age ranges 8-12 years (depends on current
composite), 6 client capacity; and Portland West and Portland East, both age ranges 12 —
18 years, 10 and 6 client capacity respectively. Shiloh's maximum capacity for the
Littleton site is 38 clients. The administrative and clinical buildings are located at the
main Littleton address. The Shiloh School at Littleton is located one block south of the
administrative buildings. Shiloh's programs address behavioral and mental health issues,
most often with accompanying issues related to abuse, neglect and trauma. The ultimate
goal is stabilization of behaviors in order to step down to a lower level of care or
reunification with the family. Youth may be placed for a short period of time to
determine and assess treatment and placement recommendations. Youth may also be
initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic, multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors(certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
Program Coordinators (on-line staff) for each of the 5 units.
One Residential Supervisor.
Clinicians (master's level and/or licensed); caseload 8-9.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Intake Coordinator(master-level and or licensed); handles referrals, intakes and
small clinical caseload.
Clinical Manager, licensed master-level; management of clinical services
and county contacts; potential small caseload.
Teachers and school counselors (ratio based on census); teachers are either
certified in Special Education or enrolled in a TTE for Special Education
Certification.
Chief of Direct Services and Clinical Director are Full Operating Level
Treatment Providers for oversight and supervision of offense specific
services.
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
All other agency departments, such as medical, human resources and
billing, are also housed at Littleton.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
1 staff to 10 (1:12 max)resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at- risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific"outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar minors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
TRCCF Scope of Services Page 2
Shiloh Home, Inc. 2008
Exhibit A
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
$j75700— $175 . 59
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie- translator attendance in weekly family
therapy.)
3) Menu of Services:—
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW,Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313;phricik@shilohhouse.net
TRCCF Scope of Services Page 3
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh Home 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 O Y\. , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#32567, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
� �- d5RZ
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include,but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
iata
Wa44
ATTEST: il
Weld County Cle - lEtfai'ti.-
q\";:1-1--)-
`)} WELD COUNTY BOARD OF
_ HUMAN SERVICES, ON BEHALF
i�" OF THE WELD COUNTY
A kg <� DEPARTMENT OF HUMAN
i>> `- ,e
(!11IN SERVICES
By: /6/11-44 41/44./ By: v 1'j��ir�
Deputy C 'rk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh Home
6400 W Coal Mine Ave
Littleto , CO 12
By: wa...
even E. alai z/CE0
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: a
Di ector
4 Weld County SS-23A Addendum
ao6c- &5
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Littleton
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF) to male youth ages eight to eighteen years old. The Littleton site is comprised
of five facilities: Yarrow and Estes offense specific milieus, age ranges 12 — 18 years, 8
clients per house capacity; Sheridan, age ranges 8-12 years (depends on current
composite), 6 client capacity; and Portland West and Portland East,both age ranges 12—
18 years, 10 and 6 client capacity respectively. Shiloh's maximum capacity for the
Littleton site is 38 clients. The administrative and clinical buildings are located at the
main Littleton address. The Shiloh School at Littleton is located one block south of the
administrative buildings. Shiloh's programs address behavioral and mental health issues,
most often with accompanying issues related to abuse, neglect and trauma. The ultimate
goal is stabilization of behaviors in order to step down to a lower level of care or
reunification with the family. Youth may be placed for a short period of time to
determine and assess treatment and placement recommendations. Youth may also be
initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic, multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors(certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
Program Coordinators (on-line staff) for each of the 5 units.
One Residential Supervisor.
Clinicians (master's level and/or licensed); caseload 8-9.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Intake Coordinator(master-level and or licensed); handles referrals, intakes and
small clinical caseload.
Clinical Manager, licensed master-level; management of clinical services
and county contacts; potential small caseload.
Teachers and school counselors (ratio based on census); teachers are either
certified in Special Education or enrolled in a TTE for Special Education
Certification.
Chief of Direct Services and Clinical Director are Full Operating Level
Treatment Providers for oversight and supervision of offense specific
services.
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
All other agency departments, such as medical,human resources and
billing, are also housed at Littleton.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
1 staff to 10 (1:12 max)resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at-risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific "outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar mirrors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
TRCCF Scope of Services Page 2
Shiloh Home, Inc. 2008
Exhibit A
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
$-l-75 $17 5 . 5 9
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie- translator attendance in weekly family
therapy.)
3) Menu of Services:-
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW,Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313;phricik@shilohhouse.net
TRCCF Scope of Services Page 3
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh House 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 o Agreement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#54169, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
1 Weld County SS-23A Addendum
aaa8- a s88
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include,but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
L______
al
Weld County Cl toalp Board
NH \ -- WELD COUNTY BOARD OF
i‘o j HUMAN SERVICES, ON BEHALF
Cj, 1: OF THE WELD COUNTY
' G DEPARTMENT OF HUMAN
SERVICES
By: By: pJl �
Deputy CI rk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh House
6400 W Coal Mine Ave
Littleton CO
BY:
Ste. en E. Ramire EO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Di ector
4 Weld County SS-23A Addendum
�o�� a5
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Littleton
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF) to male youth ages eight to eighteen years old. The Littleton site is comprised
of five facilities: Yarrow and Estes offense specific milieus, age ranges 12 — 18 years, 8
clients per house capacity; Sheridan, age ranges 8-12 years (depends on current
composite), 6 client capacity; and Portland West and Portland East, both age ranges 12—
18 years, 10 and 6 client capacity respectively. Shiloh's maximum capacity for the
Littleton site is 38 clients. The administrative and clinical buildings are located at the
main Littleton address. The Shiloh School at Littleton is located one block south of the
administrative buildings. Shiloh's programs address behavioral and mental health issues,
most often with accompanying issues related to abuse, neglect and trauma. The ultimate
goal is stabilization of behaviors in order to step down to a lower level of care or
reunification with the family. Youth may be placed for a short period of time to
determine and assess treatment and placement recommendations. Youth may also be
initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic, multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors (certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
Program Coordinators (on-line staff) for each of the 5 units.
One Residential Supervisor.
Clinicians (master's level and/or licensed); caseload 8-9.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Intake Coordinator(master-level and or licensed); handles referrals,intakes and
small clinical caseload.
Clinical Manager, licensed master-level; management of clinical services
and county contacts; potential small caseload.
Teachers and school counselors (ratio based on census); teachers are either
certified in Special Education or enrolled in a TTE for Special Education
Certification.
Chief of Direct Services and Clinical Director are Full Operating Level
Treatment Providers for oversight and supervision of offense specific
services.
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
All other agency departments, such as medical, human resources and
billing, are also housed at Littleton.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
l staff to 10 (1:12 max)resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at- risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific"outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar mirrors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
TRCCF Scope of Services Page 2
•
Shiloh Home, Inc. 2008
Exhibit A
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
-$4 -.96 $175 . 59
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie- translator attendance in weekly family
therapy.)
3) Menu of Services:—
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW,Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313;phricik@shilohhouse.net
TRCCF Scope of Services Page 3
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh House 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 o t greement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#62291, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training,mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing (3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child(30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
] Weld County SS-23A Addendum
t9004)-* c 5�
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: lax4 /4/1“ (
Weld County Clete KO11
J WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By 4,144.-- 1)446.4.1� ByDeputy O16r the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh House
6400 W Coal Mine Ave
Littleton; 801
By:
Steven E. Ramir /CEO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: a_
D ector
4 Weld County SS-23A Addendum a
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Littleton
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF) to male youth ages eight to eighteen years old. The Littleton site is comprised
of five facilities: Yarrow and Estes offense specific milieus, age ranges 12 — 18 years, 8
clients per house capacity; Sheridan, age ranges 8-12 years (depends on current
composite), 6 client capacity; and Portland West and Portland East, both age ranges 12—
18 years, 10 and 6 client capacity respectively. Shiloh's maximum capacity for the
Littleton site is 38 clients. The administrative and clinical buildings are located at the
main Littleton address. The Shiloh School at Littleton is located one block south of the
administrative buildings. Shiloh's programs address behavioral and mental health issues,
most often with accompanying issues related to abuse, neglect and trauma. The ultimate
goal is stabilization of behaviors in order to step down to a lower level of care or
reunification with the family. Youth may be placed for a short period of time to
determine and assess treatment and placement recommendations. Youth may also be
initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic, multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors (certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
Program Coordinators (on-line staff) for each of the 5 units.
One Residential Supervisor.
Clinicians (master's level and/or licensed); caseload 8-9.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Intake Coordinator(master-level and or licensed); handles referrals, intakes and
small clinical caseload.
Clinical Manager, licensed master-level; management of clinical services
and county contacts; potential small caseload.
Teachers and school counselors (ratio based on census); teachers are either
certified in Special Education or enrolled in a TTE for Special Education
Certification.
Chief of Direct Services and Clinical Director are Full Operating Level
Treatment Providers for oversight and supervision of offense specific
services.
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
All other agency departments, such as medical, human resources and
billing, are also housed at Littleton.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
1 staff to 10 (1:12 max) resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at- risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific"outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar mirrors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
TRCCF Scope of Services Page 2
Shiloh Home, Inc. 2008
Exhibit A
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
$48549— $175. 59
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie- translator attendance in weekly family
therapy.)
3) Menu of Services:—
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW,Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313;phricik@shilohhouse.net
TRCCF Scope of Services Page 3
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh House 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 greement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#70967, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$175.59 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis, based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrative
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include, but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing (3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum
0?a as6'
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
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 tcuu "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: iatig_____ ____
Weld County Cl
ai— WELD COUNTY BOARD OF
HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
1/ .47
10-11 _. 'Za
Deputy Cl fk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh House
6400 W Coal Mine Ave
Littleto , C 3
By: CleCU
even E. ami z/CEO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: t �� rA_ '�
Director
bbl
4 Weld County SS-23A Addendum
claw— /9.6
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Littleton
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF) to male youth ages eight to eighteen years old. The Littleton site is comprised
of five facilities: Yarrow and Estes offense specific milieus, age ranges 12 — 18 years, 8
clients per house capacity; Sheridan, age ranges 8-12 years (depends on current
composite), 6 client capacity; and Portland West and Portland East,both age ranges 12 —
18 years, 10 and 6 client capacity respectively. Shiloh's maximum capacity for the
Littleton site is 38 clients. The administrative and clinical buildings are located at the
main Littleton address. The Shiloh School at Littleton is located one block south of the
administrative buildings. Shiloh's programs address behavioral and mental health issues,
most often with accompanying issues related to abuse, neglect and trauma. The ultimate
goal is stabilization of behaviors in order to step down to a lower level of care or
reunification with the family. Youth may be placed for a short period of time to
determine and assess treatment and placement recommendations. Youth may also be
initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic,multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors(certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
Program Coordinators (on-line staff) for each of the 5 units.
One Residential Supervisor.
Clinicians (master's level and/or licensed); caseload 8-9.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Intake Coordinator(master-level and or licensed); handles referrals, intakes and
small clinical caseload.
Clinical Manager, licensed master-level; management of clinical services
and county contacts; potential small caseload.
Teachers and school counselors (ratio based on census); teachers are either
certified in Special Education or enrolled in a TTE for Special Education
Certification.
Chief of Direct Services and Clinical Director are Full Operating Level
Treatment Providers for oversight and supervision of offense specific
services.
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
All other agency departments, such as medical, human resources and
billing, are also housed at Littleton.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
1 staff to 10 (1:12 max)resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at- risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific "outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar mirrors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
TRCCF Scope of Services Page 2
Shiloh Home, Inc. 2008
Exhibit A
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
$-H5.00 $175 . 59
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie-translator attendance in weekly family
therapy.)
3) Menu of Services:—
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW,Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313;phricik@shilohhouse.net
TRCCF Scope of Services Page 3
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Shiloh House 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 o t Agreement remain unchanged.
1. County and Contractor, identified as Provider ID#1539982, agrees as follows:
A. Contractor will provide nine(9) guaranteed Therapeutic Residential Child Care
Facility(TRCCF)beds, located at 745 Highway 119, Longmont, CO, for the
exclusive use of the County. County agrees to pay$175.59 per day for each
guaranteed bed that is not filled by a County youth.
B. Contractor will provide Child Maintenance, Administrative Maintenance and
Services, which are listed in this Agreement at a rate of$175.59 per day for
children placed within the Therapeutic Residential Child Care Facility.
C. Contractor will provide Child Maintenance, Administrative Maintenance and
Services, which are listed in this Agreement at a rate of$175.59 per day for
children placed within the Residential Child Care Facility. RCCF placements
may be considered as guarantee beds on a case by case basis.
D. Contractor will give County youth priority placement at other facilities operated
by Contractor.
E. Additional services not covered by Medicaid or considered within the above rate
may be negotiated on a child by child basis, based on the needs of the child and in
accordance with the Colorado Department of Human Services Agency Letter
CW-06-11-I dated June 8, 2006.
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.
2. Section I, Paragraph 2. All bed hold authorizations and payments, excluding guaranteed
beds, 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.
Reimbursement rates for bed hold days may not exceed the state standard rate for
administrative maintenance and administrative services or may be a reduced rate that is
mutually agreed upon. No child maintenance will be paid for bed holds, due to the
child's absence.
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as Child
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include,but are not limited to:
Food, shelter, clothing, personal needs and allowance, administration, administrative
overhead, support staff, support overhead, sleep-over staff, direct child care,
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
] Weld County SS-23A Addendum
&2 M- asp
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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 W. 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.
2 Weld County SS-23A Addendum
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.
11. Section V, Paragraph 5. Children in 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 Human Services
Policy and Procedure Manual.
12. 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.
13. 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.
14. Add Paragraph 9 to Section VI. The Director of Human Services or designee may
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;
3 Weld County SS-23A Addendum
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 Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
15. 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.
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: ' ±'!.` : \+
Weld County Cler o s ar'd
1A WELD COUNTY BOARD OF
r / HUMAN SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By: Set . . 4124?,4> By: v ✓�L" L l ? '
Deputy clerk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
CONTRACTOR
Shiloh House
6400 W Co. 'u e Ave
Littleto , CO 8012
By: � � •o
Steven E. Ramitz/CEO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
'rector
4 Weld County SS-23A Addendum
.aeea asCf
Shiloh Home, Inc. 2008
Exhibit A
SCOPE OF SERVICES — TRCCF
Longmont
1) Scope of Service:
Shiloh Home provides community-based residential treatment services (RCCF and
TRCCF)to male youth ages eight to eighteen years old. The Longmont site is comprised
of two facilities which can house up to 22 clients. Milieus may be separated by treatment
needs, such as offense specific services and assessment services, or by current group
composite and age of clientele. The two units share clinical and educational space, both
departments housed in the main building. Shiloh's programs address behavioral and
mental health issues, most often with accompanying issues related to abuse, neglect and
trauma. The ultimate goal is stabilization of behaviors in order to step down to a lower
level of care or reunification with the family. Youth may be placed for a short period of
time to determine and assess treatment and placement recommendations. Youth may also
be initially placed for ongoing TRCCF level of care and specialized offense specific
services. Emergency access beds are available through the guaranteed contract. Youth
served by the program will have an I.Q. greater than 70, can function in a reality-based
manner, are physically healthy and are not deemed assaultive at the time of admission.
Treatment services include: individual, family, group, dyadic, multi-family group (if
census warrants feasibility of this modality), crisis intervention, case management, milieu
therapy and assessment services. Offense specific services are offered within the
specialized milieu as well as adjunct to therapeutic modalities. On-site offense specific
services follow the SOMB Guidelines. The appropriate ratio of staff as Informed
Supervisors and Therapeutic Care Providers is maintained. Clinical staff are listed with
the SOMB and therapy services are overseen and consulted by a Full Operating Level
Treatment Provider.
Program staff: Treatment counselors(certified in medication administration,Informed
Supervision/Therapeutic Care Provider,Crisis Prevention and Intervention(CPI)and CPR/First Aid.)
One Program Supervisor for the 2 units.
One Residential Supervisor(shared with Shiloh's Adams Campus).
2 Clinicians (master- level and/or licensed); caseload 8-9.
Clinical Manager(part-time), licensed master-level; management of
clinical services and county contacts; referrals/intakes; potential small
caseload.
TRCCF Scope of Services Page 1
Shiloh Home, Inc. 2008
Exhibit A
Consulting SOMB Full Operating Level Treatment Provider, LPC.
Shiloh's Chief of Direct Services and Clinical Director are also Full
Operating Level Treatment Providers to assist in oversite.
Teachers and school counselor(ratio based on census); Lead Teacher is
certified Special Education.
Support Staff(cook, maintenance, clerical).
Directors: Clinical Director, Education Director, Special Education
Director, Residential Director; All Directors overseen by Chief Officers.
Resident supervision: 1 staff to 5 resident ratio during the day(school and milieu)
1 staff to 10 (1:12 max) resident ratios during the overnight
Staff is awake 24 hours/day and provides ongoing supervision
Education services: Shiloh School provides a transitional, alternative education setting
for at- risk students by utilizing a variety of structured methodologies and a multifaceted,
research-based curriculum with a focus on affective development. Pre- and post-testing
tools are utilized to assess each client's progress, as well as testing instruments for IEP in
conjunction with the home school district. In addition to the regular school year, a
summer school program for 8 weeks is also provided which includes evidence-based
curriculum and daily academic services, and a specific"outdoor program" once/week to
offer experiential focused intervention and activities. Educational programming is
provided to the residential clients, specific to their Individualized Education Plan; regular
and special education services are offered. Shiloh's school is licensed by the Colorado
Department of Education, and the school calendar minors that of public school districts.
An Education Director and Special Education Director both supervise the school
program. School staff includes one master- level teacher certified in Special Education
and a bachelor-level teacher currently enrolled in TTE program for special education
certification; and milieu counselor. Shiloh's school maintains a teacher to student ratio
of 1:10 or less and an overall staff to student ratio of 1:5.
Average length of stay: Two weeks to 45 days for short-term and emergency
TRCCF/assessment clients; three to 6 months for TRCCF clients; 6— 12 months for
TRCCF offense specific clients.
Services to promote reduced length of stay ad positive continuum of care:
➢ Discharge planning at point of referral and intake
➢ Ongoing management meetings between Shiloh and Weld County DSS
➢ Goals developed to address immediate stabilization and preparation for step-down
care
➢ Increased frequency of FFS services per individual plan
TRCCF Scope of Services Page 2
Shiloh Home, Inc. 2008
Exhibit A
➢ Involvement of family and step-down resources
➢ Frequent case management and team meetings with multi-disciplinary team to
make efficient and timely decisions
➢ Individualized program for each clients' needs
➢ Transition work with families and providers
➢ Wrap-around and outpatient services offered via Shiloh's CORE Contract with
Weld County DSS
2) Daily Rate of Service:
'$49&.96 $175. 59
This daily rate includes any offense specific case management and therapy services
which cannot be billed under FFS system (therapy session.)
Shiloh will pay for one polygraph per client per fiscal year; Weld will pay, or arrange for
payment, for additional polygraphs.
Shiloh will pay for translator services (ie- translator attendance in weekly family
therapy.)
3) Menu of Services:—
Services which Shiloh is not able to provide, outside of the TRCCF and FFS scope, will
need to be arranged for outside service provider and fee accordingly with Weld County
DSS. (ie- additional assessments, evaluations, offense-specific evaluations, PPGs, CAC
treatment.)
If a client is placed as RCCF status and not eligible for FFS therapies, a contracted rate
for therapies will be negotiated.
CONTACT:
Pam Hricik,MSSW,LCSW
Chief of Direct Services
Shiloh Home,Inc.
303-932-9599,x313
phricik@shilohhouse.net
TRCCF Scope of Services Page 3
• WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Therapeutic Residential Child Care
Facility Services and Residential Child Care Facility Services (the
"Agreement") between Youthtrack 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 S , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of the A eement remain unchanged.
1. County agrees to purchase and Contractor, identified as Provider ID#11726, agrees to
provide:
A. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$137.90 per day for children placed within the
Therapeutic Residential Child Care Facility.
B. Child Maintenance, Administrative Maintenance and Services, which are listed in
this Agreement at a rate of$137.90 per day for children placed within the
Residential Child Care Facility.
C. Additional services not covered by Medicaid or considered within the above
vendor rate. These additional services/rates may be negotiated on a child by child
basis,based on the needs of the child and in accordance with the Colorado
Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006.
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.
2. 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. Reimbursement rates for bed hold days may
not exceed the state standard rate for administrative maintenance and administrate
services or may be a reduced rate that is mutually agreed upon. No child maintenance
will be paid for bed holds, due to the child's absence.
sa
3. Add Paragraph 6 to Section I. The services purchased under this Agreement as C9i'ild
Maintenance, Administrative Maintenance and Services for Therapeutic Residential
Child Care Facilities and Residential Child Care Facilities include,but are not lined to:
Food, shelter, clothing, personal needs and allowance, administration, administratNi e
overhead, support staff, support overhead, sleep-over staff, direct child care, w
transportation, therapeutic recreation, service delivery staff, parent training for teens,
independent living training, mentor/advocate, supervised visitation and all other services
as outlined in the Contractor's scope of service attached as Exhibit A or the Child
Specific Addendum. The anticipated minimum percentage for each item is as follows
and will be subject to County monitoring as outlined in Section VI of this contract:
A. Food, including meals and snacks (25%);
B. Clothing(3%);
C. Shelter, including utilities and use of household furnishing and equipment and
daily supervision, including those activities that a parent would normally carry out
to assure protection, emotional support and care of the child (30%);
D. Personal items and grooming care for the child, such as toothpaste, toothbrushes,
soap, combs, haircuts, and other essentials (2%);
Weld County SS-23A Addendum
p C9C953%5�
&tg
• E. Other/miscellaneous items considered usual in the care and supervision of the
child, include, but are not limited to, transportation, recreation and overhead
(40%)
4. Add Paragraph 7 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 8 to Section I. Any additional costs for specialized services, which
include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens,
that is not provided within the vendor rate or attached Scope of Service, will need be
negotiated and 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 Human Services to shorten the duration of placement.
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.
(.5J
11. Add Paragraph 16 to Section IV. Assure and certify that it and its principals _-
n,)
A. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federl
department or agency.
N
O
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;
2 Weld County SS-23A Addendum
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 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 Human 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
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 deliverages which
have not been performed and which due to circumstances caused by thF
Contractor cannot be performed or if performed would be of no value t�the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
N
C. Recover from the Contractor any incorrect payment to the Contractor dale to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Human Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
3 Weld County SS-23A Addendum
, ' ' 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.
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: /t,�yiyil it � if By: / / �
Deputy Clerk to the Board Chair Signature
William F. Garcia, Chair Pro-Tem
09/24/2008
N
O
0
C
CONTRACTOR c
Youthtrack CV
1375 Ken Pratt Blvd co
Lon CCk
By: C 5YE/ lal
v I
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
irector
4 Weld County SS-23A Addendum
n 7
Hello