HomeMy WebLinkAbout20080136.tiff RESOLUTION
RE: APPROVE REVISIONS TO OPERATIONS MANUAL, SECTION 2.000, SOCIAL
SERVICES DIVISION POLICIES AND PROCEDURES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with revisions to Section 2.000, Social Services
Division Policies and Procedures, for the Department of Social Services Operations Manual, and
WHEREAS, after review, the Board deems it advisable to approve said revisions, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the revisions to Section 2.000, Social
Services Division Policies and Procedures, for the Department of Social Services Operations
Manual, be, and hereby are, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 7th day of January, A.D., 2008.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: /6, L. /1/) S.
)Nte` � I H. Jerk Chair
Weld County Clerk to the Board 1 r "
D. Masden, Pro-Tem
BY: (.L'i i't:� ' .� /,
Deputy Cferk to the Board
Wi . arc'
APPROVE Ayr:3- -M: (Y^'1 C
David E. Long
ounty Attorney cl�
ougla Radem cher
Date of signature: /-)V-06
2008-0136
SS0035
ad,. 55 Of-ip79--ee
fit DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
IGREELEY, CO. 80632
Website: www.co.weld.co.us
Administration and Public Assistance(970)352-1551
OFax Number(970)353-5215
•
COLORADO
MEMORANDUM
TO: David E. Long, Chair Date: December 17, 2007
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services I Uk
`-
RE: Revision to Section 2.000, Social Services Division
Policies and Procedures, Weld County Department of
Social Services Operations Manual
Enclosed for Board approval is a revision to Section 2.000, Social Services Division Policies and
Procedures, Weld County Department of Social Services Operations Manual. This addition was
reviewed at the Board's Work Session held on December 17, 2007.
The purpose of the revision is to provide for a cost of living rate increase of$0.20/day for County
Certified Foster Care Homes/Kinship Care Homes to bring them in line with Child Placement
Agency rates. This cost of living increase will prepare our foster care homes for the
implementation to the Needs Based Care system on July 1, 2008. The cost of living increase is
effective January 1, 2008.
Section Citation Title of Section
2.321.1 County Foster Care, Kinship Car and Foster/Adoption Home Reimbursement
Rate
Exhibit A Weld County Addendum
Exhibit B Weld County DSS Needs Based Care Assessment
Exhibit C Weld County Department of Social Services Need Based Care Rate Table
(Form) Addendum Signature Sheet
Exhibit D Weld County Needs Based Care Addendum
If you have any questions, please telephone me at extension 6510.
2008-0136
Social Services Division Policies and Procedures
2.321 Reimbursement for County Certified Foster Care Provider
Effective 1/1/99
The Department will reimburse a county certified foster care provider if such
foster care provider meets the State reimbursement requirements of Colorado
State Rules, Section 7.405, Volume VII, Social Services Programs, and the State
requirements for County Certified Providers of Colorado State Rules, Section
7.417.1, Volume VII, Social Services Programs.
2.321.1 County Foster Care, Kinship Care and Foster/Adoption Home
Reimbursement Rate
Revised 1/01/02
Revised 6/02 According to Table 1, the Department will reimburse for the care provided by
Revised 8/5/02 County Certified foster care parents upon submittal in a timely fashion on a form
Revised 10/29/02 showing the number of days the child/ren were in care.
Revised 12/03
Revised 12/04
Revised 12/05
Revised 1/07
Revised 1/08 Table I
Age Daily Respite Care
of Maintenance Daily
Child Rate Allowance
0 months
to $16.32 $.66
10 years
11 years to
14 years $18.05 $.66
15 years to
21 years $19.27 $.66
1. The rates established by the Department will be reimbursed within
the available appropriation. The rates effective January 1, 2008,
reflect an approximate $0.20/day cost of living increase. These rates
will be in effect until June 30, 2008.
2. If the child's birthday occurs during the month, placing him in a
higher age grouping, the payment for that month is made on the
basis of the higher grouping rate.
3. County Certified foster homes are paid the basic rate, plus an additional
Respite Care Allowance of$.66 per day.
Revised 1/1/08 A. Effective July 1, 2008, the above rate structure will no longer be used
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Social Services Division Policies and Procedures
and a child specific Needs Based Care Assessment half tiered system,
designated as Exhibit B shall be used to determine levels of care for each
child placed within a County Certified foster care home. The assessment
will be completed by the County caseworker with assistance from the
Service Utilization Unit. The specific rate of payment will be paid each
level of service as recorded by the Needs Based Care Assessment. The
reimbursement rate for these levels will be indicated by the Needs Based
Care Rate Table, designated as Exhibit C. Once rates have been
established, the Needs Based Care Addendum, designated as Exhibit D, will
be completed by the County Rate Negotiator to outline the total rate of
reimbursement for the out-of-home care of the child. This addendum will
be effective from the time of placement until the end of the Colorado fiscal
year, June 30, unless otherwise negotiated. The Needs Based Care forms
have been adopted from the Northern Consortium of Counties. Effective
October 1, 2001, all providers received a 2.5% increase in administrative
overhead rate. Effective July 1, 2006, providers received a 3.25% COLA to
the administrative overhead rate. Effective July 1, 2007, providers received
a 2.5% increase to the Child Maintenance rate and the use of the new half
tiered Needs Based Care Assessment tool and Rate Table was established.
Revised 1/1/99 B. The Department shall negotiate rates with certified kinship care providers
based on the child's needs and within the County Certified Foster Care
Rate. The range shall be upward from the prevailing federal TANF
payments and is to be based on the needs of the child, plus the $.66 per day
additional respite care allowance.
Revised 1/1/08 Effective July 1, 2008, children that are placed in County certified kinship
foster care homes or a County foster/adoption home as a pre-adoption
placement, will be reimbursed at the County Basic Maintenance level on
the Needs Based Care rate table, as broken out by age, regardless of the
child's level of need. (Refer to Exhibit C) Pre-adoption placement is
defined as a placement of a child in a home that has committed to adopting
that child and the child is "legally free". Certified kinship care providers
may elect not to receive a money payment and may follow the grievance
process for foster care providers when there is disagreement about such
reimbursement rate. A child in the care of his or her parents is not
considered living in a foster home, and, therefore, is ineligible for foster
care payments, including kinship care payments. IV-E reimbursable foster
care payments may only be made to kin who are defined as an adult who is
not a parent, but who is in one of the following groups:
adm\manss.jag
Social Services Division Policies and Procedures
1. Any blood relative, including those of half-blood, and including first
cousins, nephews or nieces, and persons of preceding generations as
denoted by prefixes of grand, great, or great-great.
2. Stepfather, stepmother, stepbrother, and stepsister.
3. Persons who legally adopt a child or his or her parent, as well as the
natural and other legally adopted children of such persons, and other
relatives of the adoptive parents in accordance with State law.
4. Spouses of any persons named in the above groups even after the
marriage is terminated by death or divorce.
C. The Department will not provide non:reimbursable IV-E foster care
payments to certified kinship care providers who do not meet IV
requirements for payment.
Effective 1/1/99 D. The Department, under contract with a physician or health department,
Revised 9/18/02 will pay for annual physicals for County Certified Foster Care Home
providers and other residents of the County Certified Foster Care Home.
The County Certified Foster Care Home may obtain their own annual
physicals; however, the Department will pay for co-payments, not to
exceed $60 per person and excluding foster children.
Effective January 1, 2003, the contract with a physician for a physical and
tuberculosis testing is at a cost of$60 per person or less in the County
Certified Foster Care Home, excluding the foster child/ren. The maximum
reimbursable amount under the contract for a calendar year is $7,000.
2.321.11 Reimbursement Details for All County Foster Care Providers.
Effective 1/1/99 A. The County Certified Foster Care Rate is a flat grant that pays for the
basic maintenance needs for a child placed in any foster care facility. The
basic maintenance needs include food, clothing, shelter, education,
personal supplies and allowance.
Effective 7/1/08 Effective July 1, 2008, the provider rate, as outlined in Exhibit C, consists
of the Basic Child Maintenance rate, as set by the State and modified by
the County with cost of living increases since 1999. (Referred to as
"County Basic Maint." on Exhibit C) This reimbursement includes, but is
not limited to: Food, clothing, shelter, education, personal supplies and
allowance for children placed in any foster care home. In addition to the
County Basic Child Maintenance reimbursement, a foster care provider
may also be eligible to receive an increase in this rate due to the difficulty
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Social Services Division Policies and Procedures
of care, as assessed by the Needs Based Care Assessment tool. (As
reflected in Exhibit C, Level 1 to Level 4)
Effective 1/1/99 B. A Respite Care Allowance is paid for each child placed in a County
Certified Foster Care Home or a Child Placement Agency, and in certified
kinship care homes. It is not paid to a Specialized Group Home or Center,
or for Independent Living.
Effective 1/1/99 C. The County Certified Foster Care Rate is used as the basic maintenance
rate (flat grant portion) when computing the rate in Receiving Homes,
Group Homes/Centers, Independent Living and Subsidized Adoption
Homes.
Effective 1/1/08 Effective January 1, 2008, the County Basic Maintenance Rate is used as
the base rate when computing the rates for Group Homes/Centers,
Independent Living and Subsidized Adoption Homes.
Effective 1/1/99 D. Foster Care facilities are reimbursed by the Department as stated in
Colorado State Rules, Volume VII, and according to this Weld County
Manual. Facilities must be licensed or certified in order for the
Department to be reimbursed by the State. The foster care facilities are
reimbursed for the day in which the child is placed in the home, but are
not reimbursed for the day the child leaves it, unless the child was placed
and removed on the same day.
Effective 1/1/99 E. All certified foster care facilities will sign and use the relevant provider
contract when they are certified and recertified.
Effective 7/1/08 Effective July 1, 2008, all certified foster care providers will sign the State
prescribed provider contract and the Weld County Addendum (Exhibit A).
This contract will be effective from the time of certification or the
beginning of the Colorado State fiscal year until the end of the Colorado
fiscal year, June 30, unless otherwise indicated.
Effective 1/1/99 F. When a child is placed, the information shall be entered on the CWS-7B
Child Placement Log by the Department caseworker and the provider and
copies of the updated log shall be maintained in the provider file and by
the provider of the facility.
Revised 8/01 G. An annual clothing allowance of$200 may be made at the time of
placement out of the home to ensure that the child has an adequate
beginning wardrobe and annually thereafter for the primary purpose of
preparing the child for the initial start of the school year. A clothing
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Social Services Division Policies and Procedures
allowance is the property of a specific child who is in the custody of the
Department and is to be spend for the benefit of that child only. All
clothing purchased with these funds must follow the child upon discharge
from the foster home. Admission and discharge clothing inventories, with
the exception of expendable items, e.g. diapers, may be requested by the
Department. Original receipts must accompany any claims for
reimbursement. If a child's wardrobe is lost, stolen, or destroyed, the
Department may again approve an additional clothing allowance, the
reason for which shall be thoroughly documented in the child's record.
The clothing allowance may be made for children in County certified
foster care homes, when the Department has legal authority for placement,
and expressly pre-approved in writing by the Director.
Added 5/00 H. Transportation reimbursement is available to foster parents as mileage
Revised 1/1/02 reimbursement. The mileage reimbursement for visitation must be:
Revised 3/04
1. For mileage not covered by other resources.
2. For non-Medicaid mileage when the foster parents are not involved
in family counseling.
3. Limited to out-of-county travel.
4. In-county travel as approved for special circumstances with prior
approval of the casework's supervisor.
5. Reimbursed at two cents per mile below the standard mileage rate
allowed, pursuant to 26, U.S.C. 162 of the IRS regulations as
amended.
6. All requests for mileae reimbursements must be received in the
Department by the 25' calendar day following the month the
expenditure occurred, for the expenditure to be considered for
reimbursement. If the 25th falls on a weekend or holiday, then the
following work day.
7. All mileage reimbursement requests must be done on Form S315
County Expense Account sheet.
Added 7/2004 I. County certified Foster Care Providers will be reimbursed for any
Revised 8/1/07 Medicaid co-pay for developmentally delayed children from the age of 19
to the last day of his or her 20th birthday or for children who are deemed
ineligible for Medicaid due to non-citizenship. This co-pay will be
reimbursed the following month after the provider pays the co-pay if the
following terms are met:
1. An original receipt is turned in listing the co-pay amount(s) and
child's name; and
2. The receipt was turned in the 4th calendar day of the month after
the co-pay was paid, along with the provider roster.
Added 7/2004 J. County certified Foster Care Providers will be reimbursed the following
month after the service was provided for the last day the child or
adolescent was in the home if the following terms are met:
5 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
1. The child or adolescent was in the care of the provider until 11:00
a.m.; and
2. The child was placed in his or her permanent placement.
2.321.12 Temporary Absence
Effective 8/1/07
A. Bed hold payments for a child's temporary absence from a provider,
including hospitalization, are limited to a maximum of 3 days unless
otherwise negotiated as allowed in Volume VII. All bed hold
authorizations need to be approved, in writing within 2 working days, by
the Administrator. Once a bed hold is authorized, the Negotiator will
contact the provider to negotiate a daily rate for the approved bed hold.
6 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
WELD COUNTY ADDENDUM
(Exhibit A)
To that certain Individual Provider Contract for Purpose of Foster Care
Services and Foster Care Facility Agreement (the "Agreement") between
«First_Name» «Last_Name»
and the
Weld County Department of Social Services
for the period from July 1, 2008 through June 30, 2008.
The following provisions, made this day of , 2008, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
GENERAL PROVISIONS
1. County and Provider agree that a child specific Needs Based Care Assessment,
designated as Attachment B, shall be used to determine levels of care for each child
placed with Provider unless the child is placed in a County certified kinship foster care
home or if the child is placed in a County foster/adoption home as a pre-adoptive
placement. Kinship foster care homes and pre-adoptive placements will be reimbursed at
the County Basic Maintenance level on the Needs Based Care Rate Table, designated as
Attachment C, regardless of the child's level of need.
2. County agrees to purchase and Provider agrees to provide the care and services, which
are listed in this Agreement, based on the Needs Based Care Assessment levels
determined. The specific rate of payment will be paid for each level of service, as
indicated by the Needs Based Care Rate Table, designated as Attachment C, for children
placed within the Weld County Certified Foster Care Home identified as Provider
ID#«FACILITY_ID». These services will be for children who have been deemed
eligible for social services under the statutes, rules and regulations of the State of
Colorado.
3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's
temporary absence from a facility, including hospitalization. Bed hold requests must
have prior written authorization from the Department Administrator before payment will
be release to Provider.
4. Any additional costs for specialized services, which may include but are not limited to;
Co-pays, deductibles, or services not covered by Medicaid, will need to be authorized, in
writing by the Department Administrator, prior to the service being performed. Any
payment for specialized services not authorized in writing may be denied.
5. All reimbursement requests shall be submitted to and approved by the appropriate County
staff as set forth in the Foster Parent Handbook. Reimbursement for placement services
shall be paid from the date of placement up to, but not including the day of discharge. All
billings by the Provider must be in a format approved by the County and may be returned
unpaid if submitted in an unapproved format or inadequate documentation is provided.
All billings are to be submitted by the 4111 of each month following the month of service.
7 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
If the billing is not submitted within twenty-five (25) calendar days of the month
following service, it may result in forfeiture of payment.
6. The Director of Social Services or designee may exercise the following remedial actions
should s/he find that the Provider substantially failed to satisfy the scope of work found
in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or inaction by the Provider as outlined in the State
Department Staff Manual Volume VII and/or County Department Policy and Procedure
Manual. These remedial actions are as follows:
A. Withhold payment to the Provider until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the Provider
cannot be performed or if performed would be of no value to the Social Services.
Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Social Services;
C. Recover from the Provider any incorrect payment due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement
or other agreements between Social Services and the Provider, or by Social
Services as a debt to Social Services or otherwise as provided by law.
7. Provider shall promptly notify Social Services in the event in which it is a party
defendant or respondent in a case, which involves services provided under the agreement.
The Provider, within five (5) calendar days after being served with a summons,
complaint, or other pleading which has been filed in any federal or state court or
administrative agency, shall deliver copies of such document(s) to the Social Services'
Director. The term "litigation" includes an assignment for the benefit of creditors, and
filings in bankruptcy, reorganizations and/or foreclosure.
PROVIDER AGREES:
1. To attend or participate, if requested by the Department, in staffing a child's placement
with the Utilization Review Team. This review team convenes every Monday morning,
excluding holidays but may hold emergency staffings as needed.
2. To request a staffing if considering giving notice to remove a child, except in emergency
situations. These requests shall be made through the child's caseworker and/or the
provider's Foster Home Coordinator.
3. To cooperate with any contractors hired by Weld County Department of Social Services
or Weld County Department of Social Services staff to preserve placement in the least
restrictive placement appropriate and to comply with the treatment plan of the child.
4. To schedule physical and dental examinations within 48 hours after a child is placed in
provider's care. Medical examinations need to be completed within 10 days of the child
being placed with Provider and dental examinations need to be completed within 14 days
of the child being placed with Provider. All documentation of these examinations will be
8 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
placed in the Foster Child's Placement Information Management Binder or as indicated
in the Foster Parent Handbook.
5. To attend all necessary school meetings and support any plan that is developed regarding
the child in order to promote educational success.
6. To read, be familiar with and agree to the terms and conditions as set forth in the Foster
Parent Handbook.
7. To report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set fourth in Section 19-3-304, C.R.S.
8. To maintain/access information on the Foster Parents Internet Database On-line System
(FIDOS) as indicated in the Foster Parent Handbook.
9. To maintain/update information in the Foster Child Placement Information Management
binder. The binder may be reviewed on a monthly basis and signed off by child's
caseworker and/or the provider's Foster Home Coordinator.
10. To maintain behavior observation notes as required by the level of care assessed for each
child as indicted in the Foster Parent Handbook.
EXHIBITS: (Please refer to pages 4-7)
9 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
WELD COUNTY DSS
NEEDS BASED CARE ASSESSMENT
(Exhibit B)
IDENTIFYING INFORMATION
CHILD'S NAME STATE ID# SEX ITRAILS CASE ID DOB
M F I
WORKER COMPLETING ASSESSMENT HH# DATE OF ASSESSMENT
AGENCY NAME PROVIDER NAME PROVIDER TRAILS ID
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT
• For each question below,please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following: Therapy; Medical Treatment;
Family Visitation; Extraordinary Educational Needs; etc.,as outlined in the treatment plan?
['Basic Maint.)Less than one round trip a week ❑1)One round trip a week ❑1'/%)2 round trips a week
❑2)3-4 round trips a week. ❑2'/z) 5 round trips a week 03)6 round trips a week
❑3%:)7 round trips or more
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑ Basic Maint.)No participation required ❑1)Once a month 01%)Two times month
02)Three times a month ❑2'/:)Once a week 03)Two times a week
❑3%%)Three times a week or more
P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular or
special education plan?
❑ Basic Maint.)No educational requirements ❑1) Less than a ''/z hour per day O1%) 1/4 hour a day
02) 1 hour a day 02 %) 1'/z-2 hours per day 03)2'/:-3 hours per day
03%)More that 3 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
❑ Basic Maint.)No special involvement needed ❑1) Less than 5 hours per week 01%) 5 to 7 hours per week
❑2) 8 to 10 hours per week ❑2%) 11 to 14 hours per week
❑3)Constant basis during awake hours ❑3/)Nighttime hours
P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feeding
bathing,grooming, physical,and/or occupational therapy?
0 Basic Maint.)0-2 hours per week 01)3 to 4 hours per week 01%)5 to 7 hours per week
02) 8 to 10 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week
03%)21 or more hours per week
A 1. How often is CPA/County case management required?(Does not include therapy)
❑Basic Maint.)Face-to-face contact one time per month with child and no crisis intervention.
(i.e. mutual care placements.)
O1)Face-to-face contact one time per month with child and minimal crisis intervention.
❑1%)Face-to-face contact one time per month with child and occasional crisis intervention.
02)Face-to-face contact two times per month with child and occasional crisis intervention.
02%)Face-to-face contact three times per month with child and occasional crisis intervention.
❑3)Face-to-face contact weekly with child and occasional crisis intervention.
❑3'%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination
of multiple services,
**Please Note: The Case Management level may be assessed on a combined basis if a sibling group,or more than one
County foster child is with the same provider.
I0 Weld County Addendum to the CWS-7
Social Services Division Policies and Procedures
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
❑0)Not needed or provided by another source(i.e. Medicaid) ❑1)Less than 4 hours per month
❑2)4-8 hours per month ❑3)9-12 hours per month
11 Weld County Addendum to the CWS-7/
Social Services Division Policies and Procedures
WELD COUNTY
NEEDS BASED CARE ASSESDSSSMENT
(Exhibit B)
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Rating of Conditions
n 3.
(Check one box for each catcgor}')
AssessmentAreas Commen s:
None Mild ;Madera Severe'-
p 1 2 3
Aggression/Cruelty to Animals
❑ ❑ D ❑
Verbal or Physical Threatening
❑ ❑ ❑
Destructive of Property/Fire Setting
❑ ❑ ❑ ❑
Stealing
❑ ❑ ❑ ❑
Self-injurious Behavior
❑ ❑ ❑ ❑
Substance Abuse
❑ ❑ ❑ ❑
Presence of Psychiatric
Symptoms/Conditions ❑ El ❑ ❑
Enuresis/Encopresis
❑ ❑ ❑ ❑
Runaway
❑ ❑ ❑
12 Weld County Addendum to the CWS-7
Social Services Division Policies and Procedures
Sexual Offenses
❑ ❑ ❑ ❑
13 Weld County Addendum to the CWS-7
Social Services Division Policies and Procedures
BEHAVIOR ASSESSMENT CONTINUED
(Exhibit B)
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
_--i
a--���ng f ��1��� i ns
'o ox fm�each category
:. Assessment- eas •:`'�y: � nts - _
::-:77-24---.77---..,..-:4-7 :,. None Mild Moderate Severe y...:4,,,5-:,,,,,-.:-,--,-,--,:.--. -
:.. use ., L ; 2 - � e •
Inappropriate Sexual Behavior ❑ ❑ ❑ ❑
Disruptive Behavior
❑ ❑ ❑ ❑
Delinquent Behavior
Depressive-like Behavior
❑ ❑ ❑ ❑
Medical Needs
(If condition is rated"severe",please complete ❑ ❑ ❑ ❑
the Medically fragile NBC)
Emancipation
❑ ❑ ❑ ❑
Eating Problems ❑ ❑ ❑ ❑
Boundary Issues
❑ ❑ ❑ ❑
Requires Night Care ❑ ❑ ❑ ❑
Education ❑ ❑ ❑ ❑
Involvement with Child's
Family ❑ ❑ ❑ ❑
14 Weld County Addendum to the CWS-71
Social Services Division Policies and Procedures
CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR
ASSESSMENT:
(check level of need) ❑ 0 ❑ 1 ❑ 2 ❑ 3
15 Weld County Addendum to the CWS-7,
Social Services Division Policies and Procedures
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
NEEDS BASED CARE
RATE TABLE
(Exhibit C)
LEVEL- RECOMMENDED • MEDICAL __
AGENCY RATE THERAPY RATS
SERVICE .r ` .; PROVIDER RATE - = NEEDS
ADDEN
DUM M
_ - . Pis Al_ r°: 11
Level - :Rate Case Management Level
_= _ (Admin.Maint.) ` .- (Admin.Service!).•
Age 0-10...$16.32($496) Basic Maint $4.93 day/$15omo Level 0 $0
Age 11-14...$18.05 Therapy not needed or provided
County ($549) No crisis intervention,Minimal CPA by Level 0...$0
Basic Age 15-21...$19.27 (None)
Maint. ($586) involvement,one face-to-face visit another source,i.e.mental health.
+$-66 Respite Care
($20) with child per month.
$19.73 Level 1 $8.22 day/$250 mo Level 1 $4.93/$150 mo
+$.66 Respite Care Minimal crisis intervention as needed, Regularly scheduled therapy,
1 Level 1 ...$2.99
one face-to-face visit per month with
($20.39 day/$620 mo) child, up to 4 hours/month.
2-3 contacts per month
$23.01
1 1/2 +$.66 Respite Care Level 1 1/2 $9.86 day/$300 mo
($23.67 day/$720 mo) _
$26.30 - Level 2 $11.51 day/$350 mo Level 2 $9.86/$300 mo
2 +$-66 Respite Care Occasional crisis intervention as needed, Weekly scheduled therapy, Level 2..$4.47
($26.96 day/$820 mo) two face-to-face visits with child, 5-8 hours a month with 4 hours of
2-3 contacts per month group therapy.
$29.59
2 1/2 +$.66 Respite Care Level 2 1/2.........$13.15 day/$400 mo
($30.25 day/$920 mo)
$32.88 Level 3 $14.79 day/$450 mo Level 3 $14.79/$450 mo
+$.66 Respite Care Ongoing crisis intervention as needed, Regularly scheduled weekly
3 multiple sessions,can include Level 3..$6.02
weekly face-to-face visits with child, more
($33.54day/$1020 mo) and intensive coordination of than 1 person,i.e.family therapy,
multiple services. for 9-12 hours/monthly.
$36.16
3 1/2 +$.66 Respite Care Level 3 1/2.........$16.44 day/$500 mo ________..............
($36.82 day/$1,120 mo)
$39.45 Level 4 $18.08 day/$550 mo Level 4 $14.79/$450 mo
+$.66 Respite Care Ongoing crisis intervention as needed, Regularly scheduled weekly
4 multiple sessions,can include
RTC which includes high level of case more Level 4,...Neg.
Drop
Down ($40.77 day/$1220 mo) management and CPA involvement with than 1 person, i.e.family therapy,
child and provider and 2-3 face-to-face for 9-12 hours/monthly.
contacts .er week minimum.
Assess = $26.96 day/$820 mo
Rate (Includes Respite) $11.51 day/$350 mo
Admin.Overhead Rate: As of 7/01/07
16 Weld County Addendum to the CWS-,
Social Services Division Policies and Procedures
$6.25 day/$190.00 month
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST:
Weld County Clerk to the Board
WELD COUNTY BOARD OF
SOCIAL SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF SOCIAL
SERVICES
By: By:
Deputy Clerk to the Board (Chair Signature)
PROVIDER:
«First Name» «Last Name»
«MAILING ADDRESS»
«CITY STATE ZIP»
By:
(Signature)
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
(Director Signature)
17 Weld County Addendum to the CWS-7
Social Services Division Policies and Procedures
WELD COUNTY
NEEDS BASED CARE ADDENDUM
(Exhibit D)
This addendum supplements the Placement Agreement Form SS-23A dated between the above County
Department of Social Services and , provider# . The provider(s)hold(s)a valid and current full
certificate as a certified provider. This Addendum is effective from to , unless otherwise
negotiated.
I. THE ABOVE COUNTY AGREES TO:
• Pay the provider a rate of$_per day, prorated for the days in care, for the care of child_, State
lD#_, Case lD# . The agreed upon rate is based upon the following :
SERVICES LEVEL DAILY RATE
Provider Services $
(Child Maintenance)
Case Management Services $
(Admin.Maintenance)
Therapy Services $
(Admin.Services)
Special Medical Needs $
(Child Maintenance)
Administrative Overhead $
(Admin. Maintenance)
Total $_
• Provide support and supervision to such placement as specified in the Family Service Plan and Needs
Based Care Assessment. Involve the provider in case planning, staffing or other meetings
concerning the child, and service delivery as specified in this child's Family Service Plan and Needs
Based Care Assessment.
II. THE PROVIDER HAS MET THE PLACEMENT REQUIREMENTS OF:
n Family Foster Care n Gateway n Child Placement Agency Group Care
n Specialized Group Care n Child Placement Agency Foster Care
III. THE PROVIDER AGREES TO:
Meet the service needs as identified by the Needs Based Care Assessment and Family Service Plan. Keep
weekly records of this child's behavior and progress,submit monthly written reports to the county department,
and retain copies for own files. Submit the required forms for payment in a timely manner. The provider's
signature on the monthly payment form signifies that the above services have been provided for this child
during the month. Provide the services identified by the Needs Based Care Assessment and Individual Plan.
Meet additional requirements:
IV. This addendum shall be reviewed at least every six months in conjunction with the review of the Family
Service Plan or Needs Based Care Assessment. It shall be revised if there are agreed upon changes in the
child's service plan. It shall expire the date the child is removed, upon the renegotiation of a new addendum,
18 Weld County Addendum to the CWS-7A
Social Services Division Policies and Procedures
or upon the termination of the SS-23A Placement Agreement. The conditions of this contract may be
renegotiated at any time during the term of the contract based upon the changing service needs of the child.
Provider Signature/Date Negotiator Signature/Date
Provider Signature/Date Other Signature/Title/Date
19 Weld County Addendum to the CWS-7A
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